The ingrown toenail: unguis incarnatus

Why it forms

Cutting too short, or rounding the corners of the nail, can leave an edge that grows against the skin. Shoes that squeeze the toes, repeated trauma and the natural shape of the nail may contribute. It is not necessarily a result of poor hygiene and is not always an infection at first.

When the edge keeps pressing, the tissue reacts with swelling and sometimes with granulation tissue, which looks red and bleeds easily. Removing only the pus or using a cream may calm the signs temporarily without removing the conflict between nail and skin.

How the severity varies

In milder stages there may be tenderness and limited redness. Greater pain, discharge, overgrown tissue and difficulty walking indicate a need for assessment. The doctor distinguishes local irritation from infection spreading into surrounding tissues.

A thickened nail from another disease, an injury or inflammation around the nail may resemble this condition. When the appearance is unusual or does not improve, the diagnosis should be reviewed. Do not continue the same treatment for months without clarifying why the problem returns.

What you can do in a mild case

Reduce pressure with shoes that are wide at the toes and keep the area clean and dry. In people without risk factors, short soaks in lukewarm water may ease discomfort; dry thoroughly afterward. If there is discharge or the pain is increasing, seek medical advice.

Do not dig at the corner with scissors, do not pierce the skin and do not apply chemicals to burn it. Repeatedly cutting the edge too deep can create a spike that feeds the problem. Placing materials under the nail or mechanical correction requires professional selection and guidance, especially when the area is inflamed.

When a prompt consultation is needed

Pus, spreading redness, significant pain or recurrences require assessment. In people with diabetes, loss of sensation, poor circulation or lowered immunity, even a small wound should not be treated by cutting the nail yourself. The absence of pain may be linked to neuropathy and does not guarantee safety.

A toe that is cold, very pale or darkened, and rapid worsening, require urgent assessment.

What is assessed and when a procedure is needed

The doctor examines the edge of the nail, the surrounding tissue and signs of infection. They consider circulation, sensation, accompanying illnesses and previous procedures. An antibiotic may be needed when there is a defined infection, but it does not correct the edge that continues to damage the skin.

When conservative treatment is not enough or the condition recurs, removal of part of the nail under local anesthesia at the relevant service may be discussed. In selected cases, the matrix, the area that produces the problematic edge, is also treated to reduce recurrence. Removal of the whole nail is not automatically necessary. The choice takes into account infection, healing and the patient’s preferences.

Frequently asked questions

How should I cut my nails to prevent it? Cut the nail straight, without rounding the corners and without cutting too short, so that the edge does not grow against the skin. Do not dig at the corner with scissors. Choose shoes with enough room at the toes, especially if you spend a lot of time on your feet.

Is an ingrown toenail always infected? No. At first there may only be tenderness and redness from pressure. Infection is considered when pain, pus, swelling and spreading redness increase. An antibiotic may be needed only when there is a defined infection and it does not by itself solve the problem of the nail edge.

When should part of the nail be removed? When conservative treatment is not enough or the condition recurs. The procedure is done under local anesthesia at the relevant service and, in selected cases, the matrix is also treated to reduce recurrence. Removal of the whole nail is not automatically necessary.

Why does diabetes change care? In diabetes, reduced sensation and poor circulation can hide pain and delay healing. A small wound may worsen unnoticed, so these patients should not treat the nail themselves and should seek assessment earlier.

Follow-up and prevention

After a procedure, follow the instructions about the dressing, washing, activity and the check-up. Discharge and healing time vary with the technique; worsening, a heavy odor and spreading redness should be reported. No procedure guarantees complete absence of recurrence.

Once settled, nails are cut straight, without cutting too short and without digging at the corners. Choose shoes with enough room. If you cannot see or reach your toes well, seek qualified help with care, especially when you have diabetes or a circulation problem.

Care at Tirana Polyclinic: We offer surgical consultation to assess the ingrown toenail and the factors affecting healing. We clarify conservative treatment and the need for a procedure at the relevant service.