What is included in the conservative treatment of ingrown nails?

Updated: Nov 06, 2020
  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD  more...
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Answer

Cotton wick insertion in the lateral groove corner is one method. Using a nail elevator or small curette, small wisps of cotton are inserted under the lateral edge of the ingrown nail. Symptomatic improvement was reported in 79% of patients in a case series with mean follow up of 24 weeks. [24] See the image below.

Schematic view for cotton wick insertion. Courtesy Schematic view for cotton wick insertion. Courtesy of Dermatology Research and Practice (Haneke, E. "Controversies in the Treatment of Ingrown Nails." Dermatology Research and Practice. 2012; 2012:783924).

Toe taping is an alternative method. The affected toe is taped in a way that the one end of the tape is placed on the side of the ingrown nail along the granulation tissue and twisted around the toe at an angle, with the other end overlapping the first without covering the wound itself. This taping allows drainage of accumulated pus, drying of the wound, and decreasing the pressure on the nail bed. [25] See the image below.

Schematic view illustrating taping of the nail. Co Schematic view illustrating taping of the nail. Courtesy of Dermatology Research and Practice (Haneke, E. "Controversies in the Treatment of Ingrown Nails." Dermatology Research and Practice. 2012; 2012:783924).

Nail splinting by flexible tube (gutter treatment) involves a small sterilized vinyl intravenous drip infusion tube, which is cut and slit appropriately from top to bottom with one end cut diagonally for smooth insertion. The lateral edge of the affected nail plate is splinted with this tube under local anesthesia. The plastic tube is then covered by adhesive or wound closure strips and the patient is instructed to wash his or her toe daily with povidone iodine solution for 3-4 weeks. This method allows the nail spicule to grow without injuring the nail fold, and the inflammatory process will subside. [26] See the image below.

Schematic view illustrating gutter technique. Cour Schematic view illustrating gutter technique. Courtesy of Dermatology Research and Practice (Haneke, E. "Controversies in the Treatment of Ingrown Nails." Dermatology Research and Practice. 2012; 2012:783924).

The split tape-strap technique is a procedure that involves elastic tape cut into pieces about 3 cm wide and about 10 cm long, folded longitudinally in half. A slit is then created on the width of the ingrown nail along the short edge of one third of the tape length. The ingrown nail is then inserted in the slit, orienting the tape with the shorter side of the tape towards the dorsal side of the toe and hooking the slit edge of the longer side on the ingrown nail and attaching it to the plantar surface of the toe. This procedure showed favorable results as monotherapy or when combined with other conservative procedures. [27]

Other methods reported to be effective but on a smaller number of patients include angle correction technique, [28] dental floss technique, [29] nail wiring, [30] nail brace, [31] knot technique, [32] Nishioka procedure, [33] and use of an artificial acrylic nail. [34]


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