%0 Journal Article
%T Controversies in the Treatment of Ingrown Nails
%A Eckart Haneke
%J Dermatology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/783924
%X Ingrown toenails are one of the most frequent nail disorders of young persons. They may negatively influence daily activities, cause discomfort and pain. Since more than 1000 years, many different treatments have been proposed. Today, conservative and surgical methods are available, which, when carried out with expertise, are able to cure the disease. Packing, taping, gutter treatment, and nail braces are options for relatively mild cases whereas surgery is exclusively done by physicians. Phenolisation of the lateral matrix horn is now the safest, simplest, and most commonly performed method with the lowest recurrence rate. Wedge excisions can no longer be recommended 1. Introduction Ingrown toenails are a common condition of school children and young adults but may be observed at virtually any age. Their treatment is often frustrating for the patient as it may be associated with considerable and long-lasting morbidity and quite frequently with permanently distorted toes and nails. 2. Terminology The controversy begins already with the term: whereas most physicians call the condition ingrown or ingrowing nail (unguis incarnatus) since the nail plate is believed to be the cause [1], others insist that it should be named onychocryptosis as the nail is only covered by hypertrophic lateral nail wall tissue [2]. 3. Types and Aetiopathogenesis of Ingrown Nails There are several different types of ingrowing nails (Table 1). The most common form is distal-lateral ingrowing. The aetiopathogenesis is usually a wide, relatively markedly curved nail plate, the distal lateral corners of which have been cut obliquely leaving a tiny spicule that digs into the lateral nail groove and finally pierces the epidermis when the nail grows forward (Figure 1). This causes a foreign body reaction with inflammation, granulation tissue, secondary bacterial colonization, and eventually infection [2]. Precipitating factors are narrow pointed shoes, tight socks, hyperhidrosis, juvenile diabetes mellitus, and many more [1]. Table 1: Types of ingrowing nails. Figure 1: Schematic illustration of the adolescent type of ingrown nail. (a) Oblique view. (b) Dorsal view. In the most common form, ingrowing usually starts at the distal end of one or both of the lateral nail grooves. The tip of the toe is compressed in a narrow tipped shoe, and when the nail is cut short or the distal corner has been cut off, the distal nail bed is allowed to shrink so that there is no more enough space for the regrowing wide nail (Figure 2). It pushes on the soft tissue which may first react with a
%U http://www.hindawi.com/journals/drp/2012/783924/