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Gandhinagar's 1st Laser center for Dermatology and Cosmetology


Dermatology Surgery >> Nail Surgery
Ingrowing toenails
  • Common problem in adolescents and young adults
  • Usually affects the hallux but other nails may be affected
  • Due to lateral edge of nail cutting and growing into adjacent soft tissue
  • Bacterial or fungal infection may be superimposed
  • Attempted healing may result in over granulation nail bed
  • Possible aetiological factors include:
  • Poorly fitting shoes
  • Poor foot care
  • Inappropriate nail cutting


  • In the early stages conservative management should be attempted
  • This should include:
  • Regular soaking and washing of feet
  • Careful drying after washing
  • Well fitting shoes
  • Education into cutting nails transversely
  • Possible use of pledgets of cotton wool under nail to encourage growing out
  • Surgery may be required if conservative measures fail
  • Nail can be removed by:
  • Avulsion of the whole nail
  • Wedge resection of the involved side of the nail
  • Recurrence is common
  • If simple avulsion fails ablation of the nail bed should be considered
  • This can be achieved either chemically or surgically
  • Chemical ablation can be achieved with phenol
  • Surgical removal usually involves a Zadek's procedure
  • Avulsion and phenolisation is more effective than surgical procedures

Subungual haematoma

  • Result from blunt trauma to the hallux and nail bed
  • Blood collects under the nail
  • Increased pressure causes severe pain
  • Nail initially appears red
  • Becomes purple as blood coagulates
  • Differential diagnosis includes:
  • Subungual melanoma
  • Glomus tumour
  • Kaposi's sarcoma
  • Haematoma can be evacuated by nail trephine with needle or drill
  • Blood under pressure is released
  • Symptoms immediately settle
  • Onychogryphosis

The nails in systemic disease

  • Abnormalities of the nail my indicate the presence of systemic disease
  • Examination of the nails is an important part of any physical examination Clubbing
  • Clubbing is the loss of the normal angle between the nail and nail bed
  • Associated with:
  • Bronchogenic carcinoma
  • Bronchiectasis
  • Congenital heart disease
  • Liver cirrhosis


  • Thin brittle, concave nails
  • Often associated with iron-deficiency anaemia
  • Also seem following nail trauma and lichen planus Splinter haemorrhages
  • Small, linear steaks of blood in the long axis of the nail
  • Caused by haemorrhage from vessels of the nail bed
  • Due to microemboli from bacterial endocarditis

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