eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Ingrown Nails

Author: Ann G Egland, MD, Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Jul 19, 2006

Introduction

Background

Ingrown toenails are a fairly frequent cause of discomfort. Although often thought to be synonymous, the terms ingrown nail and paronychia refer to different conditions. Both can cause significant discomfort. Ingrown toenails may cause pain with ambulation.

Pathophysiology

Ingrown nails result from an alteration in the proper fit of the nail plate in the usual nail groove. Sharp spicules of the lateral nail margin develop and are gradually driven into the dermis of the nail groove. The nail acts as a foreign body. An inflammatory response occurs in the area of penetration, leading to erythema, edema, purulence, and development of granulation tissue.

Development of ingrown nails is divided into 3 stages: (1) erythema, edema, and focal tenderness; (2) crusting and expressible purulence at the nail fold and nail plate junction; and (3) chronic infection with protuberant granulation tissue extending over the nail plate.

Ingrown nails generally occur as the result of poorly fitted footgear. However, this may be caused by prior trauma to or abnormal shape of the nail margin.

Frequency

United States

Of all nail problems, this is the most common. Toenails are affected much more commonly than fingernails. The lateral margins of the great toe are most frequently affected.

International

In the United Kingdom, 10,000 cases per year have been reported.

Mortality/Morbidity

In general, mortality is not associated with ingrown nails. Morbidity is chiefly the result of infection of the tissues. If neglected, abscess formation (paronychia) may occur or spread and lead to osteomyelitis, systemic infection, sepsis, or amputation.

Race

No racial bias appears to exist.

Sex

The prevalence of ingrown nail has a reported male-to-female ratio of 3:1.

Age

The condition is observed in people of all ages but is most common in the second decade of life.

Ingrown nails become much more common as children begin bearing weight on their feet and wearing shoes.

Clinical

History

Patients present for care of ingrown nails due to discomfort. Ingrown nails may cause significant pain.

If a toenail is involved, the discomfort worsens with weightbearing and ambulation.

  • The patient with an ingrown nail presents with a sharp, focal pain adjacent to the nail bed of the affected digit.
  • The patient or parents may typically describe crusting, purulence, and friable granulation tissue at the site.

Physical

On examination, the following may be present:

  • Edema or inflammation of tissue surrounding the nail bed
  • Erythema of the same tissue
  • Macerated or friable granulation tissue
  • Crusting
  • Drainage
  • Hypertrophy of the nail margin
  • Hypertrophy of the surrounding epidermis

Causes

The nail plate can be forced out of the nail groove by footgear that has a toe box that is too small for the forefoot, by trauma, or by cutting the nail back in a curvilinear fashion.

  • Other causes include the following:
    • Heredity - Some people are genetically predisposed to inwardly curved nails with distortion of one or both nail margins.
    • Underlying bony pathology causing deformation of the nail
    • Obesity causing deepening of the nail groove
    • Antiviral therapy for HIV has also been reported to have an association with increased incidence of ingrown nails.
    • Prior trauma resulting in an irregularly shaped nail

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

  2. Gross RH. Foot pain in children. Pediatr Clin North Am. Dec 1986;33(6):1395-409. [Medline].

  3. Ilfeld FW. Ingrown toenail treated with cotton collodion insert. Foot Ankle. Apr 1991;11(5):312-3. [Medline].

  4. 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].

  5. Noronha PA, Zubkov B. Nails and nail disorders in children and adults. Am Fam Physician. May 1 1997;55(6):2129-40. [Medline].

  6. Rich P. Nail disorders. Diagnosis and treatment of infectious, inflammatory, and neoplastic nail conditions. Med Clin North Am. Sep 1998;82(5):1171-83, vii. [Medline].

  7. Robbins JM. Recognizing, treating, and preventing common foot problems. Cleve Clin J Med. Jan 2000;67(1):45-7, 51-2, 55-6. [Medline].

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

  9. Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. Cochrane Database of Systematic Reviews. 2004;1.

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

Further Reading

Keywords

ingrown nails, ingrown fingernail, ingrown toenail, acronyx, onychocryptosis, unguis incarnatus, unguis aduncus

Contributor Information and Disclosures

Author

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
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.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of 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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