REFERAT:

INGROWING TOE NAIL

Advisor :
dr. Evelyn Aryani Pranowo
Supervisor:
dr. Muji Iswanti, SpKK, SH,
MH.Kes, M.kes
DERMATOVENEREOLOGY DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY
MAKASSAR
2016
By :
R. Awanda Syahrul C11111909
Eka Cresentia Tonapa C11111910
Rezky Auliah Ikhsan C11112911
Evelyn Natasya Lotisna C11112914
 PREFACE
An ingrown toenail is a toenail that
has grown into the skin instead over
it.
The soft tissue at the side of the nail
plate, resulting in pain, sepsis and
later the formation of granulation
tissue.
 The ingrown nail is often diagnosed in
school children, adolescents, young
adults, and pregnant women.
Two main causes are tight shoes and
an incorrect nail-trimming technique.
Shoes that fit properly may reduce
the pressure between the nail and the
lateral nail fold, cutting the toenail in
wrong direction.
 Drugs such as isotretionoin,
lamivudine, and indinavir may induce
periungual granulation tissue
mimicking onychocryptosis.
 In mild cases, soaking the foot in
warm soapy water and insertion of a
cotton pad, dental floss, or a flexible
plastic tube beneath distal corner of
the offending nail may make surgery
unnecessary.
 Potent topical steroid can be useful to
diminish inflammation and suppress
granulation tissue but can only be used
when infection is ruled out or being actively
managed. If the infection is more severe
and there is local cellulitis, an appropriate
systemic antibiotic should be administered.
When granulation tissue forms this should
be destroyed by cauterization with a silver
nitrate stick.
 The best way to prevent
onychocryptosis is to protect feet
from trauma by wearing comfortable
shoes with adequate room for the
toes. Cut the toenail straight across
instead of semilunar shape, and
always keep the hygiene.
ANATOMY OF NAIL
Vascularization & Innervation of Nail
 PHYSIOLOGY OF NAIL
The nail develops during the 9th embryonic
week
Start from the epidermis of the dorsal tip of the
digit, the nail fold that is delineated by a
continous groove.
Proximal border of the nail fold extends
downward and proximally in to the dermis to
from the nail matrix primordium.
15th week the nail matrix is completely
developed and starts to produce the nail plate.
 PHYSIOLOGY OF NAIL
Nail plate has a thickness of about
0,5 mm in women and 0,6 mm in
man, there is an increase in nail
thickness with age, particularly in the
first two decade.
Nail growth of about 1,8 4,5 mm
per month or 0,1 mm per day.
 FUNCTION OF THE NAIL
Protecting the distal phalanges
Enhancing tactile discrimination and
the capacity to pick up small objects.
Toenails protect the distal toes and
contribute to pedal biomechanics.
What causes ingrown toenails?

ill-fitting shoes and improperly trimmed nails.

Ill-fitting shoes such as tight shoes, high heels
and pointed-toe shoes cause the toes to be
compressed together so that the nail curls
into the skin and cannot grow normally.
Improper trimming of toenails can cause the
nail edge or corner to dig into the skin.
Toenails should be trimmed straight across so
that the top of the nail should make a straight
line.
 Injury near the nail such as a ripped nail or
nail peeled off at the edge can cause an
ingrown toenail.
Fungal infections ot the nailcan cause a
thickened or widened toenail to develop.
Prescribed medications, particularly oral
retinoids such asisotretinoinandacitetrin.
 are the signs and symptoms of ingrown toena
wn toenails can be classified into 3 stages according to sever

Stage Features
1 End of the toe becomes reddened with mild swelling
May feel warm and be painful to touch
No pus or drainage

2 Toe becomes increasingly red, swollen and painful

May be white or yellow coloured pus or drainage from the area
Infection may have developed

3 Symptoms of redness, swelling and pain are increased

Granulation tissue forms and adds to the swelling and discharge of pus
Lateral nail-fold hypertrophy (overgrowth of skin tissue around the affected toe)
More severe infection with fever may follow
 Diagnostic
Diagnostic tests are not usually required, but if a
particular cause is suspected appropriate tests can
be ordered, e.g. nail clippings and scrapings of
subungual debris for fungal culture and microscopy.
When deciding on the most appropriate treatment
method to manage a patient with an ingrown
toenail a number of factors need to be taken into
consideration, including:
The severity of the pain and inflammation and if
infection is present
Whether the patient has previously presented with
an ingrown toenail
 What treatments have been
previously tried and if the treatment
was successful
Patient preference and co-
morbidities, e.g. some people may
not like the cosmetic results of
surgical options and people with
certain co-morbidities, e.g. diabetes,
may not be candidates for some
surgical treatments
 History

Patients with an ingrown toenail have a

painful, swollen, and tender toe.
When infection is present, the patient
may have local discharge.
Important components of the history
include a previous history of risk
factors for diabetes and arterial
insufficiency.
 Physical

The affected toe has all the classic signs of infection:

pain, edema, erythema, and warmth.
Lymphangitis is rare.
The affected side is readily apparent.
Inspection for other contributing causes, particularly
mycoses, is important. An exam of the foot will show
the following:
Skin along the edge of the nail appears to be growing
over the nail, or the nail seems to be growing
underneath the skin.
Skin is swollen, firm, red, or tender to touch. There
may be a small amount of pus.
 Workup
Your doctor will most likely be able to
diagnose your toe with a physical exam.
If your toe seems infected, you might
need an X-ray. This can show how deep
the nail is. An X-ray may also be taken if:
Your ingrown nail was caused by injury.
You have a history of chronic infections.
Your pain is severe.
Xray imaging
 DIFFERENTIAL DIAGNOSIS
Multiple periungual pyogenic
granulomas secondary to oral
retinoids or antiretroviral agents.
Pincer nail.
 TREATMENT
Conservative
soaking the foot in warm water followed by
application of topical antibiotics and topical
corticosteroids
Using a nail elevator or small curette, small
wisps of cotton are inserted under the
lateral edge of the ingrown nail.
Nail splinting by flexible tube (gutter
treatment)
cauterization with a silver nitrate stick
Cotton Nail
Insertion Splinting
Surgical Care
Partial nail avulsion followed by
chemical matricectomy using 80 to
88% phenol (phenolization)
 Figure 1. Ingrown Figure 2. Figure 3. Separation of
left great toenail Application of the nail from the nail
(medial tourniquet. bed with a nail elevator.
right edge of the
nail).

Figure 4. Cutting the ingrown Figure 5. Application of

portion of the nail with a nail phenol to the nail matrix.
 COMPLICATION
Paronychia
If left untreated, chronic inflammation may
cause skin bridging secondary to
epithelialization of the adjacent inflamed
hypertrophied soft tissue. Keloid formation
may result from chronic inflammation,
especially in cases of recurrent ingrown nails.
Recurrence is defined as the occurrence of
pain, discomfort, erythema, and/or drainage
at the site of the treated nail edge.
 PROGNOSIS
Prognosis is good if the therapy
proper with the degree of severity,
and if no complication.

With surgical can give a good result,.

 PREVENTION
Good hygiene and wearing appropriately
sized footgear are important.
Shoes with narrow, pointed toes that
compress the forefoot should not be worn.
Wearing well-fitted shoes with a wide toe
box or open toe are recommended.
Proper toenail trimming. Toenails should
be cut straight across, and the corners
should not be rounded off.
 CONCLUSION
Ingrown Toenail is the condition which the nail
grows in to the skin, which in normal condition
the nail should grows over the surface.
This disease can be caused by the trauma.
For the treathment can be carried out in
accordance with the severity. For the mild can
be given conservative therapy, and than for
the severe degree can use surgery.
With the proper treathment, ingrown toenail
can be cured eithout causing complications.
TERIMA
KASIH