Infected Ingrown Toenail (Antibiotics, No Excision)

An ingrown toenail occurs when the nail grows sideways into the skin alongside the nail. This can cause pain. It can also lead to an infection with redness, swelling, and sometimes drainage.

The most common cause of an ingrown toenail is trimming your nails wrong. Most people trim the nails too close to the skin and try to round the nail too tightly around the shape of the toe. When you do this, the nail can grow into the skin of your toe. It's safer to trim the nail ending in a straight line rather than a curve.

Other causes include injury or wearing shoes that are too short or tight. This can cause the same problem that happens when trimming your nails. Your genetics can also make this more likely to happen.

The following are the most common symptoms of an ingrown toenail: 

  • Pain

  • Redness

  • Swelling

  • Drainage

If the infection is mild, you may be able to take care of it at home with the following measures:

  • Frequent warm water soaks

  • Keeping it clean

  • Wearing loose, comfortable shoes or sandals

Another method involves using a small piece of cotton or waxed dental floss to gently lift up the corner of the problem nail. Change the cotton or floss frequently, especially if it gets dirty.

If your infection is mild, and the above methods aren’t working, or if the infection gets worse, see your healthcare provider. Signs of worsening infection include:

  • Swelling

  • Redness

  • Pus drainage

  • Increased pain

In some cases, you may need antibiotics along with warm soaks. If after 2 to 3 days of antibiotics the toenail doesn't get better or gets worse, part of the nail may need to be removed to drain the infection. With treatment, it can take 1 to 2 weeks to clear up completely.

Home care

Wound care

For the next 3 days, soak and clean your toe in warm water a few times a day.

  • Twice a day for the first 3 days, clean and soak the toe as follows:

    1. Soak your foot in a tub of warm water for 5 minutes. Or, hold your toe under a faucet of warm running water for 5 minute

    2. Clean any remaining crust away with soap and water using a cotton swab.

    3. Put a small amount of antibiotic ointment on the infected area.

  • Change the dressing or bandage every time you soak or clean it, or whenever it becomes wet or dirty.

  • If you were prescribed antibiotics, take them as directed until they are all gone.

  • Wear comfortable shoes with a lot of toe room, or open-toe sandals, while your toe is healing.

Medicines

  • You can take over-the-counter medicine for pain, unless you were given a different pain medicine to use. Note: Talk with your provider before using these medicines if you have chronic liver or kidney disease, ever had a stomach ulcer or digestive bleeding, or are taking blood-thinner medicines.

  • If you were given antibiotics, take them until they are used up or your provider tells you to stop, even if the wound looks better. This makes sure that the infection clears up.

Prevention

To prevent ingrown toenails:

  • Wear shoes that fit well. Don't wear shoes that pinch the toes together.

  • When you trim your toenails, don't cut them too short. Cut straight across at the top and don’t round the edges.

  • Don’t use a sharp object to clean under your nail since this might cause an infection.

  • If the toenail starts to grow into the skin again, put a small piece of waxed dental floss or cotton under that side of the nail to help it grow out straight.

Follow-up care

Follow up with your healthcare provider, or as advised. If the antibiotic doesn't work, or if the condition happens again, you may need to have part of the nail removed.

When to seek medical advice

Call your healthcare provider right away if any of the following occur:

  • Increasing redness, pain, or swelling of the toe

  • Red streaks in the skin leading away from the wound

  • Pus or fluid drainage

  • Fever of 100.4°F (38°C) or higher, or as directed by your provider

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