eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Ingrown Nails: Differential Diagnoses & Workup

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Ann G Egland, MD, Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Jul 20, 2009

Differential Diagnoses

Impetigo
Lymphangitis
Obesity
Osteomyelitis
Staphylococcus Aureus Infection
Streptococcal Infection, Group A

Other Problems to Be Considered

Bunion
Candidiasis
Cellulitis
Foreign body
Fracture
Herpetic whitlow
Junctional nevi
Mucous cysts
Onychomycosis
Paronychia
Periungual fibroma
Pyogenic granuloma
Subungual exostoses

Workup

Laboratory Studies

  • Usually, no laboratory studies are required in patients with ingrown nails. Potassium chloride (KOH) and fungal culture may be considered, if indicated by physical examination findings suspicious for a fungal etiology.

Imaging Studies

  • Radiography may be appropriate to rule out fracture, foreign body, or suspected osteomyelitis as indicated by history and physical examination.

More on Ingrown Nails

Overview: Ingrown Nails
Differential Diagnoses & Workup: Ingrown Nails
Treatment & Medication: Ingrown Nails
Follow-up: Ingrown Nails
Multimedia: Ingrown Nails
References

References

  1. Martinez-Nova A, Sanchez-Rodriguez R, Alonso-Pena D. A new onychocryptosis classification and treatment plan. J Am Podiatr Med Assoc. Sep-Oct 2007;97(5):389-93. [Medline].

  2. Grassbaugh JA, Mosca VS. Congenital ingrown toenail of the hallux. J Pediatr Orthop. Dec 2007;27(8):886-9. [Medline].

  3. Lee JH, Kim SE, Park K, Son SJ. Congenital ingrown toenails successfully treated with simple plastic tube insertion. Int J Dermatol. Feb 2008;47(2):209-10. [Medline].

  4. Sarifakioglu E, Yilmaz AE, Gorpelioglu C. Nail alterations in 250 infant patients: a clinical study. J Eur Acad Dermatol Venereol. Jun 2008;22(6):741-4. [Medline].

  5. Luther J, Glesby MJ. Dermatologic adverse effects of antiretroviral therapy: recognition and management. Am J Clin Dermatol. 2007;8(4):221-33. [Medline].

  6. Shaikh FM, Jafri M, Giri SK, Keane R. Efficacy of wedge resection with phenolization in the treatment of ingrowing toenails. J Am Podiatr Med Assoc. Mar-Apr 2008;98(2):118-22. [Medline].

  7. Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. Cochrane Database Syst Rev. Apr 18 2005;CD001541. [Medline].

  8. Bostanci S, Kocyigit P, Gurgey E. Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails. Dermatol Surg. Jun 2007;33(6):680-5. [Medline].

  9. Yang G, Yanchar NL, Lo AY, Jones SA. Treatment of ingrown toenails in the pediatric population. J Pediatr Surg. May 2008;43(5):931-5. [Medline].

  10. [Best Evidence] Bos AM, van Tilburg MW, van Sorge AA, Klinkenbijl JH. Randomized clinical trial of surgical technique and local antibiotics for ingrowing toenail. Br J Surg. Mar 2007;94(3):292-6. [Medline].

  11. Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. Feb 15 2009;79(4):303-8. [Medline].

  12. Czarnowski C, Ponka D, Rughani R, Geoffrion P. Toenail resection: minor surgery video series. Can Fam Physician. Nov 2008;54(11):1555. [Medline].

  13. Chapeskie H. Ingrown toenail or overgrown toe skin?: Alternative treatment for onychocryptosis. Can Fam Physician. Nov 2008;54(11):1561-2. [Medline].

  14. Aksoy B, Aksoy HM, Civas E, Oc B, Atakan N. Lateral foldplasty with or without partial matricectomy for the management of ingrown toenails. Dermatol Surg. Mar 2009;35(3):462-8. [Medline].

  15. Orenstein A, Goldan O, Weissman O, et al. A comparison between CO2 laser surgery with and without lateral fold vaporization for ingrowing toenails. J Cosmet Laser Ther. Jun 2007;9(2):97-100. [Medline].

  16. Ishibashi M, Tabata N, Suetake T, et al. A simple method to treat an ingrowing toenail with a shape-memory alloy device. J Dermatolog Treat. 2008;19(5):291-2. [Medline].

  17. Moriue T, Yoneda K, Moriue J, et al. A simple therapeutic strategy with super elastic wire for ingrown toenails. Dermatol Surg. Dec 2008;34(12):1729-32. [Medline].

  18. [Guideline] Gahagan S, Silverstein J. Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. American Academy of Pediatrics Committee on Native American Child Health. Pediatrics. Oct 2003;112(4):e328. [Medline].

  19. Edlich RF, Winters KL, Britt LD. Bacterial diseases of the skin. J Long Term Eff Med Implants. 2005;15(5):499-510. [Medline].

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  22. Information from your family doctor. Ingrown toenails. Am Fam Physician. Feb 15 2009;79(4):311-2. [Medline].

  23. Manusov EG, Lillegard WA, Raspa RF. Evaluation of pediatric foot problems: Part I. The forefoot and the midfoot. Am Fam Physician. Aug 1996;54(2):592-606. [Medline].

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  27. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. Mar 15 2001;63(6):1113-6. [Medline].

  28. Zuber TJ. Ingrown toenail removal. Am Fam Physician. Jun 15 2002;65(12):2547-52, 2554. [Medline].

Further Reading

Keywords

ingrown nails, acronyx, ingrown fingernail, ingrown toenail, onychocryptosis, paronychia, unguis incarnatus, unguis aduncus, sepsis, osteomyelitis, obesity, diagnosis, treatment

Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Ann G Egland, MD, Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center
Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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