Onychocryptosis

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Onychocryptosis / ‘Ingrown Nail’

Part of nail (spike or edge) penetrates epidermis  inflammatory reaction + infection – mostly in hallux.

Clinical features:
One or both sulci may be affected. Initially slight discomfort  progresses. Affected periungual tissue becomes erythematous, hot, oedematous and shiny  throbbing pain. May be infected and malodorous. Continued irritation  hypergranulation tissue. This excess hypergranulation tissue overlaps the nail, partially obscuring it

Predisposing factors:
• Involuted nail
• Axial rotation of toe
• Pressure from footwear
• Poor nail cutting technique
• Previous trauma
• Hyperhidrosis

Zaias- 3 stages:
1) Minimal injury to sulcus and symptoms mild
2) Acute pain and erythema
3) ‘overgrowth otepiobmal tissue

Differential diagnosis – subungual exostosis; glomus tumour; onychophosis; paronychia

Treatment:
Conservative - remove offending piece of nail by use of nail nippers, chisel or scalpel blade with or without local anaesthetic. High probability of recurrence if predisposing factors still present.
Antibiotics are not necessarily indicated if offending ‘splinter’ of nail is removed.
Surgical removal of part of nail with destruction of nail bed and matrix

Nail Surgery

Related
Ingrown Toe nail

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