eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Ingrown Nails: Follow-up

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

Follow-up

Further Inpatient Care

  • Ingrown nails are usually treated on an outpatient basis.

Further Outpatient Care

  • Provide appropriate follow-up care as indicated.
  • Provide patients and parents with specific indications for return, such as development of infection, bleeding, or any worsening of the condition of the digit.

Deterrence/Prevention

  • Good hygiene and wearing appropriately sized footgear are important. Shoes with narrow, pointed toes that compress the forefoot should not be worn.
  • Teaching the patient and parents to keep the nail margin in the nail groove, how to properly trim the nail, and how to choose shoes with an accommodating toe box is vital to prevent further visits.

Complications

  • Development of paronychia is the most common complication. If paronychia is not treated, the condition may progress to cellulitis, osteomyelitis, or systemic infection.
  • If neglected, abscess formation (paronychia) can spread and lead to osteomyelitis, systemic infection, and sepsis; amputation of the digit may even be required for definitive treatment.
  • Although infrequent, postsurgical infection may occur in a small percentage of patients. Appropriate precautions should be given to return for any signs of infection or fever.

Prognosis

  • Prognosis is excellent. Complete healing is expected.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Pitfalls include misdiagnosis of ingrown nail when more widespread infection is present and failure to recognize associated trauma, such as fracture of the affected digit.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Thomas Craig, MD, and Ann Egland, MD, to the development and writing of this article.



More on Ingrown Nails

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

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Further Reading

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Keywords

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

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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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