Ingrown nail - Causes, symptoms and treatment. MF.
An ingrown nail is an ingrowth of the inner or outer edge of the nail plate 1 of the toe finger into the nail roller. This disease is quite common, occurs in childhood and adulthood. It affects mainly the outer edge of the nail bed.
Causes of ingrown nail.
There are 2 main causes of ingrown nail plate:
• Incorrect nail trimming .
If the wrong nail cutting technique is applied too deep towards the base, the lateral edges of the nail plate are cut, which leads to incorrect growth of the nail and ingrowth into the soft tissues of the finger;
• Wearing narrow shoes .
The second reason is wearing uncomfortable tight and narrow shoes, especially with a sharp nose. In this nail plate under the pressure of the walls of the footwear is forced to cut into the nail roller, constantly injuring it. As a result, a purulent sore is formed, pathological granulations( so-called "wild meat") grow.
Nail plate growth is possible in the same way:
• with flat feet;
• with fungal nail damage, which causes deformation, thickening of the nail, contributing to ingrowth into the soft tissues of the finger;
• after a nail injury. Symptoms of ingrown nail.
The main symptom of an ingrown nail is a constant pain in the region of the nail roller, which increases with walking and wearing shoes. When examined at the very beginning of the disease, you can see the small size of the sore in the place where the nail roller is constantly traumatized. When joining the infection( which occurs quickly enough), there may appear scarce purulent discharge. Further, there is an increase in pathological granulations - this is an excessive proliferation of tissues in the wound region of the nail roller in response to trauma and infection. Such granulations have the color of raw meat, for which they were called "wild meat".With their appearance, the disease acquires a chronic course, significantly hindering walking.
The figure shows a typical picture of an ingrown nail - there are pathological granulations, scant purulent discharge.
Examination with ingrown nails.
If you find these symptoms, you should consult a surgeon in the clinic. Specific examination is not required, it is necessary to give a general blood test to assess the severity of the inflammatory process;assess blood sugar is necessary to exclude the presence of diabetes.
With the development of complications, which will be discussed later, it will be necessary to perform radiography of the foot bones, since a purulent process can pass to the bone.
If you suspect a fungal infection, you need to undergo treatment with a dermatologist, since without eliminating the cause of the disease, it's pointless to treat its consequences.
Treatment for ingrown nails.
Treatment in the absence of complications is performed on an outpatient basis in a polyclinic. At the very beginning of the disease, when the infection and pathological granulations are not expressed, conservative treatment is carried out, which is also used to prepare for surgical treatment. It is necessary to exclude the mechanical effect on the nail plate. This is achieved by wearing loose comfortable shoes with a wide nose, it's even better to walk around for a while barefoot or in shoes with an open front part( sandals, flip flops).It is necessary to abandon the short nail cutting, which increases its ingrowth.
Conservative treatment of ingrown nail
Twice a day you need to perform warm baths with salt water, it helps soften the skin and the nail plate. To reduce the degree of inflammation in parallel it is necessary to perform baths with a weak solution of potassium permanganate( manganese) or baking soda. Effective laying between the nail and skin roller gauze strips impregnated with 0.5% hydroalcoholic solution of chlorhexidine, which, as they dry up, re-wet, reaching a permanent presence of an antiseptic solution in the wound area. In addition, the paving of the gauze strip reduces the mechanical effect on the nail roller, which helps to reduce pain and more rapid healing of the wound.
Previously, the use of narrow strips of a radiographic film between the nail and the dermal roller was used, this also eliminated the mechanical factor of the injury, and this also led to a gradual extension of the deformed nail plate. Currently, there are special devices in the form of springs, plates, staples, performing the same function. An example is shown in the photo.
Due to their small size, they absolutely do not interfere with the wearing of shoes. Raising the edges of the nail, they help reduce pressure on the nail roller, reduce pain and correct the shape of the nail.
The appearance of pathological granulations and purulent discharge reveals the neglect of the process and the need for surgical treatment.
Surgical treatment of ingrown nail
There are several types of surgical procedures performed to correct ingrown nails. They are performed under local anesthesia with a 2% solution of lidocaine or a 0.5-1% solution of novocaine. It is necessary to remember about possible allergic reactions to these drugs right up to anaphylactic shock. Therefore, always check with the doctor the name of the drug, which he will carry out anesthesia and tell if you have had allergic reactions to this drug.
The easiest way to treat an ingrown nail is to remove part or the entire nail plate. The nail will grow for 3 months, at which time the nail bed will not be protected, and any mechanical effect on it will cause painful sensations, at least the first weeks.
The positive results of a simple removal of part or all of the nail plate are not high. Very often the nail grows again. This is due to increased due to inflammation of the okolonogtevogo roller. Therefore, in order to increase the efficiency of the operation, in parallel with the removal of a part of the nail plate, scraping and removal of pathological granulations, the plastic of the perio-oral gland is produced.
The plastic of the nail roller is performed as follows: an oval incision on the side surface of the finger removes a part of the skin and sews the edges of the formed wound with nodal sutures. As a result, due to the tension of the okolonogevoy roller is turned and stops contacting the nail plate. This allows achieving a stable remission of the disease.
Currently, modern technologies are used to treat ingrown nails. The least traumatic method of surgical treatment of this disease is laser correction. Under the influence of high temperature of the laser beam, the ingrown part and the edge of the nasal germ zone are evaporated. At the same time, they eliminate pathological granulations and foci of infection. The laser is also used for fungal lesions of the nail plate, with the help of it, all the subungual space is sterilized from fungal spores.
Complications of ingrown nail.
The most common complications occur in the chronic course of ingrown nails. The development of complications is facilitated by:
• diabetes mellitus;
• obliterating atherosclerosis of the vessels of the lower extremities.
In these diseases, the blood supply to the soft tissues of the finger is impaired, which reduces their ability to regenerate and resistance to infection.
As a result, the following pathological conditions develop.
• Lymphangitis and lymphadenitis - the infection spreads through the lymph vessels, causing their inflammation( lymphangitis) to the nearest lymph nodes( popliteal and inguinal lymph nodes), where it lingers, causing their increase and pain syndrome( lymphadenitis).
• Abscess of the toe - purulent inflammation of the soft tissues of the finger, accompanied by swelling and redness of the entire nail phalanx, requires surgical intervention.
• Osteomyelitis of the nail phalanx of the finger - the transition of a purulent infection to the bone, it is difficult to treat, an amputation of the phalanx of the finger may be required. Diagnose the results of radiographic examination of the bones of the finger.
• Gangrene toes of foot - irreversible necrosis of soft tissues of foot, accompanied by blackening of the skin. The only treatment is amputation of the nail phalanx or the entire toe.
Prevention of ingrown nail.
A number of simple rules must be observed.
• Wearing loose shoes.
• Treatment of orthopedic diseases( flat feet).
• Personal hygiene.
• Timely treatment of a fungal infection in a dermatologist.
• Compliance with the correct nail cutting technique. The nail should be cut in a straight line, passing not lower than the tip of the finger, with sharp straight manicure scissors. The edges of the nail should be filed with a nail file in the corners, so that they are smooth and do not injure the skin.
If the first signs of the disease occur, you should consult a surgeon. In the early stages of the disease can be cured without surgery!
As J. Rousseau said: "Most of our diseases are the work of our own hands."Therefore, observe simple rules and live easily.
Surgeon physician. DS