The onychocryptosis It is the inflammation caused in the soft parts of a finger due to injuries caused by the nail. The process is the product of the penetration of the nail into the surrounding tissue and the consequence is a wound of varying degree that causes pain and inflammation. Infection of the affected area is frequent.
It is commonly known as an ingrown toenail, describing its production mechanism. It is a frequent disease that occurs both in the fingers of both feet and in the hands, being more frequent in the hallux or first toe. General symptoms include pain, edema, redness, and limitation of gait due to pain..
It is more common in males, perhaps due to habits and type of footwear. The frequency by sex will depend in any case on the habits and activities in a given population. Adolescents and young adults are more susceptible to onychocryptosis.
The importance of the prevention, diagnosis and treatment of onychocryptosis lies in how painful and even disabling it can be. The individual, labor and economic implications justify the timely attention of the cases that arise. Correct hygiene and the use of appropriate footwear are necessary preventive practices.
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Pain is the main symptom in onychocryptosis, and it is present even in the mildest cases. Edema, redness, purulent discharge and deformity are the symptoms associated with this disease. In some cases, itching occurs as a result of inflammation of the affected tissue.
The pathophysiological aspects of this disease explain the symptoms and the different stages in which it can occur.
The edge of the nail penetrates the periungual soft tissue, producing the initial injury. The nail behaves like a foreign body, producing a local reaction with the release of substances that promote inflammation. Factors such as edema, nail growth, and trauma will worsen symptoms of pain and swelling.
The formation of abscesses and granulomas is a consequence of the persistence of the local reaction. An abscess occurs due to the invasion of bacteria into the wound, while a granuloma consists of a hyperplasia of the skin and subcutaneous cellular tissue in contact with the foreign body..
According to the severity of the clinical picture and associated symptoms, there is a classification of onychocryptosis. This classification or staging provides the therapeutic orientation in each case..
Clinical signs of local inflammation are observed. It is common to see a slight swelling and redness; the nail does not exceed the limits of the nail bed.
The pain is usually mild or occurs due to pressure on the affected area. Signs and symptoms may disappear spontaneously. May require only hygiene including nail trimming.
The edema, redness and localized pain are more intense. There may be increased sensitivity of the area. The possibility of associated infection is high, with serous or purulent discharge. The nail usually exceeds the limit of the nail bed and the granuloma begins to form.
Stage II can be divided into two parts. Stages IIa and IIb are differentiated by the measurements of the associated granuloma: if it is less than or greater than 3 mm, respectively. The granuloma is an inflammatory response that supposes a hypertrophy of the soft tissue.
Soft tissue hypertrophy is so severe that the granuloma can cover the nail.
Nail plate deformity becomes apparent and the affected finger begins to lose its normal appearance.
It affects both the lateral folds and the tip of the finger, producing a marked deformity. The normal anatomy of the finger is lost, producing chronic nail deformity. There may be spread of the infectious process to neighboring areas.
The causes of onychocryptosis are due to circumstances that produce the penetration of the nail into the soft tissue. Factors such as wearing tight shoes, trauma, and improper nail trimming are among the main causes. There are also special circumstances that produce the disease such as fungal infection.
Some of the most frequent causes have to do with hygienic habits, habitual activity, occupation and predisposition.
- Inadequate hygiene and incorrect nail trimming.
- Use of inappropriate footwear, either tight or very closed.
- Hyperhidrosis, or excessive sweating.
- Contact with chemicals or pollutants.
- Onychophagia Deforms the edge of the nail and salivary enzymes weaken it.
- Trauma.
- Finger deformities, such as pathological angulation of the hallux.
- Onychomycosis, which causes deformity.
- Paronychias. Inflammation of the edge of the finger triggers onychocryptosis.
- Nail weakness or brittleness.
- Obesity.
- Diabetes, due to poor blood supply and predisposition to nail deformity.
- Nail psoriasis, due to the deformity it causes.
- Inheritance.
Taking into account the relative disability that onychocryptosis produces, adequate and timely treatment will provide the patient with rapid symptomatic relief and return to their usual activities..
Treatment guidelines depend on the degree of involvement of the affected limb, as seen in the stages.
- Avoid wearing closed or tight shoes.
- Washing the affected area with antiseptic solutions.
- Placement of creams based on antibiotics, anti-inflammatory drugs (NSAIDs) or steroids.
- Physical rest.
It is intended to improve symptoms and prevent infections. It includes the treatment and care of predisposing pathologies, such as diabetes and psoriasis.
In a second stage, the extraction of the nail fragment that causes the clinical picture may be necessary. This therapy is reserved for stage I and even IIb.
- Oral or parenteral antibiotics.
- Analgesics, anti-inflammatories.
- Topical treatment with creams.
- Mechanical elevation of the nail edge, with the use of cotton or dental floss.
- Removal of the foreign body or fragment. May include partial onychectomy.
- Management of predisposing factors.
Surgery is reserved for medical specialties such as surgery, dermatology, trauma, or podiatry. Surgical treatments are used in stages IIb, III and IV. Reconstruction of the chronically deformed finger is a therapeutic approach.
- Onychrectomy is the removal of the nail attachment, which can be partial or total. It is performed both instrumentally and through the use of chemicals.
- In matricectomy, in addition to the extraction of the nail, part of the affected nail bed can be removed. Includes removal of granulomas or hypertrophied tissues.
- Reconstructive Plastic Surgery.
The correct therapeutic approach will provide the patient with a complete recovery and a reduction in recurrences. All procedures must be accompanied by the necessary information for the correct care of hands and feet..
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