Clive Anderson - AT THE DERMATOLOGISTINGROWN NAILS are caused by changes in the nail plate. These changes result in the nail plate no longer fitting into the nail grove in the skin at the sides of the nail but gradually growing downwards into the skin.
Sharpened edges on the nail are driven into the dermis of the skin at the edges of the nail. The nail then becomes a foreign body breaking the skin barrier and introducing bacteria and other microorganisms into the skin. An inflammatory response develops as the skin mobilises its defence mechanisms to fight off the invaders. An infection of the skin results.
The symptoms associated with an ingrown nail develop in three stages. First, there is redness, some swelling and tenderness when pressed. This is stage 1. Second an exudate develops. The exudate may be bloody and pus filled stage 2. The third stage is chronic infection and granulation tissue may develop protruding from the sides of the ingrown nail.
Ingrown nails may occur at any age but are most common after age 20. There is a male female ratio of 3:1. This condition is the most commonly occurring of all nail problems. The causes of ingrown nails are many, and include improper fitting shoes where the toe box is too small, trauma to the nail or cutting the nail in a curved fashion. Poor cutting of the nail or tearing the nail can leave a sharp edge or small spike that will grow into the skin. Trauma may result in a deformed nail that is more likely to grow into the sides.
PERSONS WITH DIABETES
Other less common causes are hereditary curving of the nail pincer nails, pathology of the bone or obesity. Anyone can develop ingrown nails, but you may be more prone to develop this condition if you have toenails that grow downwards or grow faster at the edges than at the centre. Ingrown nails are also more common in older adults, as the nails tend to thicken with age. The curvature of thickened nails tends to be greater resulting in the sides curving into the flesh.
If left untreated an ingrown nail; can infect the underlying bone and lead to serious bone infection. The complications are particularly severe if the person has diabetes. This is because the circulation and nerve supply to the foot is often impaired. As a result any injury to the foot can lead to serious complications like the formation of difficult-to- heal ulcers that may require surgery.
TO HELP PREVENT INGROWN NAILS:
Trim toenails straight across. Do not curve the nails to match the shape of the toe.
Keep toenails at a moderate length. Cut nails at the edge of the toe. If nails are too short, the pressure from the shoe may force the nails inward, too long nails are more likely to be traumatised.
Wear shoes that fit properly and protective footwear if your work puts you at risk of trauma to the foot.
If you have poor circulation in the feet see your health professional for a foot check every three months.
CUTTING TISSUE
The treatment of ingrown nails depends on the stage involved. In stage one warm soaks of the toe along with elevating the nail edge with a cotton swab may be all that is necessary for resolution of the problem. Cut the nail straight across and allow the edge to grow past the tissue.
In stage two, in addition to the above, treatment of infection with an oral or topical antibiotic may be required.
Stage three is treated by removing the portion of the nail that is sticking into the skin and cutting away any granulation tissue that may have formed. This is an office procedure that may also involve the ablation of the nail bed to prevent the regrowth of that area of the nail.
Dr. Clive Anderson is a dermatologist and venereologist; email: yourhealth@gleanerjm.com.
