Thursday, May 28

What causes ingrown toenails

  ›     ›   Treatment   ›   What are the causes of ingrown toenails?

What causes ingrown toenails?

Ingrown toenail, or onychocryptosis, is a common painful disease, usually affecting the big toenail.
Ingrown toenail is usually caused when the toenail plate penetrates into the adjacent lateral skin fold. Several anatomic and behavioral factors can contribute to onychocryptosis.

Anatomical factors contributing to onychocryptosis include overgrown skin fold around the ungual plate or malformed toenails. Behavioral factors which cause onychocryptosis include poor foot hygiene, improper trimming, tearing toenails off, hyperhidrosis (excessive sweating), repetitive trauma such as running or kicking, or inadvertent trauma such as stubbing the toe.

Factors predisposing lower extremity edema such as obesity, hypothyroidism, cardiac, and renal disorders can also increase the likelihood a person developing onychocryptosis. In older persons, spicule formation and thickening of ungual plate are the causes of ingrown, painful, and infected onychocryptosis.
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This condition is thought to have a genetic predisposition and family history in certain cases. There are several cases of congenital ingrown toenails in newborns.

Poor foot hygiene

Our feet are the most abused and neglected part of our body. Tired, sore and neglected feet can develop several problems. Cleaning the feet every evening before going to bed and keeping them dry will keep nearly half of the foot health problems out. Dusty, dirty and moist toenails can contract fungal infections and cause onychocryptosis.

Improper trimming

Improper trimming of toenails may cause onychocryptosis. Toenails should be trimmed straight across. Trimming too close or rounding off the ungual plate edges will result in bulging of soft tissue around it leading to soft tissue injury. Cutting back the lateral margins in a curved manner should be avoided. The toenail edges should extend past the tissue of the lateral skin fold.

Hyperhidrosis

In adolescence, feet perspire more often which causes the ungual plate to become soft and prone to splitting. Further, participation in sports or physical activities result in the production of ungual plate spicules. The excessive sweating also causes maceration of the skin of the toenail folds. Such condition makes it easier for the ungual plate or spicules to pierce the surrounding skin.
image of ill fitting shoe caused ingrown toenail
infected ingrown toenail caused by ill-fitting shoes

Overgrown skin folds

One school of thought is that the toenail is not the real culprit, and that the excess skin surrounding the ungual plate is the real problem. Some individuals have unusually wide area of tissue medial and lateral to the toenail. With weight bearing, this tissue tends to bulge up around the ungual plate, leading to pressure necrosis, and cause the ungual plate to pierce into the soft tissue. The Vandenbos procedure targets removing these excess skin fold around the toenail.

Ill-fitting footwear

Tight-fitting shoes, narrow toed or pointed shoes or high heeled shoes place constant pressure on the median skinfold and also on lateral skin fold by pushing the big toe against the second toe. Such pressure can cause the toenail plate to cut into the surrounding tissues. Proper footwear with a wide toe area is to be prefered. Tight socks also can create similar problems. If shoes are too loose, toes may constantly hit against the shoe and again increase the chances of developing ingrown ungual plate.

Toenail deformities

Ungual plate apparatus may have several congenital abnormalities. Secondary deformities may arise due to trauma or anatomical conditions. These abnormalities can initiate onychocryptosis. Excessively curved toenail is more curved from side to side rather than being flat. Such a toenail can become ingrown into the adjacent skin fold. Increased or reduced ungual plate thickness, medial rotation of the hallux and related structural abnormalities, deformed shape of the ungual plate, thickened skin folds around the plate can become contributing factors for onychocryptosis.

Congenital factors

Congenital onychocryptosis may be caused by intrauterine disorders or hereditary factors. A newborn may have excessive growth of skin folds surrounding the toenail, congenital hypertrophic lip of hallux, distal embedding with normally directed ungual plate, distal lateral embedding, congenital malalignment of the big toenail or overcurvature of the ungual plate. All these conditions may induce and cause ingrown toenails.

Ingrown toenail in old age

Toenails undergo several physiological changes and histological modifications in geriatric populations. These changes are caused by the impairment in circulation, susceptibility to infections, skin disorders, reduced mobility, foot deformities and systemic diseases. They may not be able to take adequate care of legs and feet. The toenails get thickened, hardened and brittle. Poor eyesight, trembling and inability to bend and reach their feet leads to improper trimming of toenails. They tend to stub their toes quite often due to gait problems. These conditions make them prone to have ingrown ungual plate.

Genetic predisposition

Cambiaghi S et al. in their report titled 'Congenital hypertrophy of the lateral nail folds of the hallux in twins,' published in British Journal of Dermatology (1997) described a case of onychocryptosis in twins. The report suggested the possibility of genetic predisposition to onychocryptosis in some cases.

Other common causes

  • Onychocryptosis and paronychia have been reported secondary to use of medications, such as indinavir, retinoids, docetaxel and cyclosporin.
  • Subungual neoplasms may result in chronic ingrown conditions by compression on to hard surface of ungual plate.
  • Stubbing of toes or repeated injuries to toes may lead to ingrown ungual plate.
  • As said earlier systemic diseases such as hypothyroidism, cardiac and renal disorders with predisposition to lower extremity edema can cause ingrown conditions.
  • Fungal infections of the toenail cause the ungual plate to become brittle and break into spicules. The spicules may pierce the surrounding skin fold and grow into it.
  • Picking or tearing at the corners of the toenails can also cause an ingrown condition.
  • Improper posture which transfers much of the body weight on to the toes can influence chances of developing ingrown toenails.

Ingrown toenail treatment

Mild, initial stages of onychocryptosis can be treated with conservative approaches, such as soaking the foot in warm, soapy water, placing cotton wisps or dental floss under the ingrown ungual plate edge, using gutter splint or applying topical antibacterial preparations. For highly infected or recurrent ingrown toenail, surgical correction is the treatment of choice.
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References on ingrown toenail:
1.Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2.Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrown toenails? Arch Fam Med. 2000;9(9):930–932.
3.DeLauro NM, DeLauro TM. Onychocryptosis. Clin Podiatr Med Surg. 2004;21(4):617–630.
4.Khunger N, Kandhari R. Ingrown toenails. Indian J Dermatol Venereol Leprol. 2012 May-Jun;78(3):279-89.
5.Chapeskie H. Ingrown toenail or overgrown toe skin? Alternative treatment for onychocryptosis. Can Fam Physician 2008;54:1561-2.
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Current topic in natural skin care: What are the causes of ingrown toenails.
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Saturday, May 23

What is an ingrown toenail - Onychocryptosis

  ›     ›   What is an ingrown toenail - Onychocryptosis definition.

What is an ingrown toenail?

Ingrown toenail, medically termed as onychocryptosis or unguis incarnatus is a common painful nail disease. Onychocryptosis, often affects the great toenail (hallux).
Onychocryptosis can be defined as a condition in which the toenail grows cutting into one or both sides of the nail bed. Onychocryptosis may also occur due to overgrown skin fold around the toenail. Pain, swelling and discharge are the main clinical features of onychocryptosis.

Diagnosis is apparent with inflamed reddened toe characterized by nail-fold swelling, erythema, edema, and pain with pressure. The toenail disease can cause significant morbidity and hamper the quality of life by interfering with daily activities.

Several treatment options are available. If the onychocryptosis is in its initial stage conservative methods of treatment such as treatment with warm water and salt soaks,antibacterial ointment and using dental floss or a gutter splint to provide a track for the nail to grow can be opted. If the toenail is highly infected or recurrent, surgical correction is the treatment of choice.
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Onychocryptosis web definition
The definition of onychocryptosis according to collinsdictionary.com is "a form of nail disease in which nails are ingrown".
The lexbook.net defines as "Onychocryptosis, also known as an ingrown toenail, or unguis incarnatus is a common form of nail disease."

Several anatomic and behavioral factors contribute to onychocryptosis. Some of the factors are:
  • poor foot hygiene,
  • improper trimming of the nails,
  • ill-fitting shoes,
  • cutting the nail too short,
  • rounded off at the corners of toenail,
  • peeling off nails,
  • stubbing the toenail,
  • dropping things on the toe,
  • pressure on the skin around the nail,
  • footwear bunching the toes,
  • abnormally shaped nail beds,
  • overcurvature of the nail plate,
  • too much skin around the nail,
  • thick nail folds,
  • lower extremity edema,
  • pressure necrosis of tissue around the nail,
  • hyperhidrosis and softening of skin around the nail,
  • nail deformities caused by diseases,
  • bacterial or fungal infections,
  • genetic predisposition to onychocryptosis and
  • congenital onychocryptosis.
image of wounded infected toenail
wounded infected ingrown toenail

Treating ingrown toenail

There are several conservative as well as surgical options available for treating onychocryptosis. Some of the treatment options are:
  • soaking the foot in warm, soapy water,
  • applying topical antibiotic or steroid ointment,
  • placing cotton under the onychocryptosis corner,
  • inserting dental floss under the onychocryptosis edge,
  • placing gutter splint,
  • correcting the convexity of the nail by reducing its thickness,
  • using nail wire or brace to reduce convexity of onychocryptosis nail,
  • partial nail avulsion,
  • total nail excision,
  • phenolization,
  • electrocautery,
  • matricectomy and
  • laser ablation of the onychocryptosis nail matrix.
Following a regular foot and toenail care regimen will keep onychocryptosis at bay.
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References on ingrown toenail:
1.Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2.Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrown toenails? Arch Fam Med. 2000;9(9):930–932.
3.DeLauro NM, DeLauro TM. Onychocryptosis. Clin Podiatr Med Surg. 2004;21(4):617–630.
4.Khunger N, Kandhari R. Ingrown toenails. Indian J Dermatol Venereol Leprol. 2012 May-Jun;78(3):279-89.
5.Chapeskie H. Ingrown toenail or overgrown toe skin? Alternative treatment for onychocryptosis. Can Fam Physician 2008;54:1561-2.
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Current topic in natural skin care: What is an ingrown toenail - Onychocryptosis definition.
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Friday, May 15

Ingrown hair definition - What is ingrown hair?

  ›     ›   What is ingrown hair and its definition.

What is ingrown hair?

Ingrown hair is a condition wherein a hair grows at an abnormal angle and grows sideways into the skin.
It may cause inflammation, pain and tiny bumps in the affected area. Though in most cases it appears in areas where the skin is shaved, tweezed or waxed, it can involve any hairy area on the body. When the angle of growth of hair is disturbed and is cut or broken off with uneven sharp tip, it may grow sideways penetrating the skin causing this condition.

Ingrown hair is common in individuals who shave very close to the skin. The ingrown condition is more prevalent in people with curly or coarse hair. Shaving against the direction of growth can increase the chances of razor burn and ingrown condition. The condition usually resolves by itself. Treatment may become necessary when the ingrown condition involves skin infection, folliculitis or pseudofolliculitis barbae.
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Web definition
The American Heritage® Stedman's Medical Dictionary definition of the condition is "A hair that grows at an abnormal angle and turns back into the skin, causing the formation of a pustule or papule".
The drugs.com definition is "An ingrown hair occurs when a shaved or tweezed hair grows back into the skin. It can cause inflammation, pain and tiny bumps in the area where it was removed".
Dictionary.kids.net.au defines as "a hair that does not emerge from the follicle but remains embedded in the skin (usually causing inflammation)".

What is the cause of ingrowth?

As said earlier, the naturally coarse or tightly curling thick hair, while growing back after a shave, may curl and pierce the skin and grow into it. This condition is known as extrafollicular ingrowth in which the shaft after exiting the follicle reenters the skin. In transfollicular condition the hair does not exit the follicle and it curls back and grows into the skin.
image of ingrown hair
Ingrown hair being removed
A common polymorphism in a keratin gene (K6hf) may be a genetic risk factor for pseudofolliculitis barbae type of ingrowth. Blocking of the follicle by hard dead skin may also induce ingrown condition. Excessive circulating androgen hormones may promote excessive coarse hair growth and increase the risk factors. Continued friction on the skin and tight-fitting clothing may also cause these ingrowths.

What does an ingrown hair look like?

These ingrowths produce raised, often inflamed red bumps, which may look like inflamed pimples. Infected ingrowths may collect pus and become itchy, painful and uncomfortable.

Prevention

The best way to prevent this condition is to allow the hair to grow naturally on the face and body. The next effective alternative is to use beard trimmer at the lowest setting. If shaving is a must, however, be sure to do it right. Moisturize the area of skin to be shaved with warm water and use a new sharp razor blade. This will prevent the hard (without moisturization) shaft of hair from being pulled by the rough razor blade, upsetting its root and its angle of growth.

Applying the proper amount of lubrication in the form of shaving cream or gel, may prevent the stubble from being forced sideways into the skin. One should avoid applying pressure on the skin with razor. Applying pressure on the skin while shaving or shaving against the direction of hair growth may cut it far below the skin level and contribute to its growth into the skin.

What is the treatment for ingrown hair?

Totally avoiding shaving for three to four weeks may resolve the existing ingrown bumps. Extrafollicular ingrowths can usually be pulled gently from under the skin, with tweezers and cut above the skin level. Completely pulling out the ingrown hair from its follicle may alter the angle of growth of subsequent shafts and increase the risk of further ingrowths. Transfollicular ingrowths may require removal by a dermatologist. Some of the treatment options for ingrown hairs are, chemical depilatories, topical creams, laser treatment and surgical removal.
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References on ingrown hair:
1.Ribera M, Fernández-Chico N, Casals M. [Pseudofolliculitis barbae]. Actas Dermosifiliogr. 2010 Nov;101(9):749-57.
2.Alexis A, Heath CR, Halder RM. Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin. 2014 Apr;32(2):183-91.
Image source: http://en.wikipedia.org/wiki/File:Eingewachsenes_Haar_2010.jpg
Image author: LBPics | Image license: CC BY-SA 3.0
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Current topic in natural skin care: What is ingrown hair and its definition..
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Tuesday, May 5

Becker's nevus - Becker melanosis

  ›     ›   Becker's nevus - Becker melanosis.

What is Becker's nevus?

Becker's nevus (BN), also known as Becker's melanosis, is an unilateral, cutaneous hamartoma predominantly affecting males.
This form of pigmented nevoid melanosis was first described by American dermatologist, Samuel William Becker (1894–1964), in the year 1948. It is characterized by a large, hyperpigmented macule with irregular borders and late-set hypertrichosis.

The nevoid melanosis involved common sites are the trunk, arm, shoulder, chest, face, flank, buttock and leg. It tends to be more conspicuous in male patients, becoming apparent during adolescence. It appears to be androgen-dependent as it becomes more prominent after puberty and there is increased hairiness of the affected area. In some cases intralesional acne may develop. Researchers have also reported increased number of androgen receptors in the lesion when compared with unaffected skin.

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The frequency of Becker's pigmentary hamartoma is considered to be around 0.2% in the population. However, the prevalence can be much higher as the lesion may be less conspicuous in women and may go unnoticed and often get overlooked or misdiagnosed. These melanosis lesions are initially pale in color. They darken and become more conspicuous after sun-exposure. As the melanosis progresses, new macules develop beyond the margin of the initial patch and coalesce with it, giving a geographical contour. Fresh satellite macules may keep developing.

Becker's melanosis pathogenesis

The cause of Becker's pigmentary hamartoma is not fully understood. Though there are congenital cases, the lesion usually develops during childhood and early teenage years. Possibly a small patch of skin with the predisposition for these melanosis lesions may be present at birth. Male hormones contribute to its progression and its changes during puberty. The epidermis at the site shows mild acanthosis and hyperkeratosis with regular elongation of rete ridges.

Becker's melanosis complications

Malignant melanoma had been documented in patients with Becker's pigmentary hamartoma. Several cases of congenital BN have been reported. Book SE et al. reported a case of congenital Becker's pigmentary hamartoma with a familial association. A 16-month-old Child had a patch of melanosis on his right shoulder and upper pectoral area, extending down his arm. The patient's father also had a similar macule with hair on his left shoulder right from his childhood. The authors concluded that, "We believe this to be the first reported case of a congenital Becker's nevus with a familial association."
Becker melanosis - Becker's nevus
Becker melanosis - Becker's nevus
Sumit Kar et al. reported a 22-years-old male with coexistent Becker's nevus and type 1 neurofibromatosis. Neurofibromatosis type 1 is an autosomal dominant multisystem disorder, with cutaneous, neurologic and orthopedic manifestations. Mutation in neurofibromin gene located at chromosome 17q11.2 causes type 1 neurofibromatosis. It is a rare association of both the ailments in one individual.

George Issa et al. reported a case of giant BN and concurrent epidermal nevus (EN) in a 70 years old patient. He had a hyperpigmented scaly plaque extending along his left lateral thigh, knee and leg. "The biopsy of which demonstrates hyperkeratosis with acanthosis and increased pigmentation at the basal layer, consistent with an EN." There was also a lesion on the trunk which was diagnosed as Becker's pigmentary hamartoma.

Becker's Nevus Syndrome (BNS)

BNS is an association of nevoid melanosis with several unilateral developmental abnormalities of different organ systems such as breast hypoplasia, supernumerary nipples, aplasia of the pectoralis major muscle, mentally retardation, short stature, spina bifida, scoliosis, congenital adrenal hyperplasia, cardiac defects and an accessory scrotum.

Becker's melanosis treatment

The nevoid melanosis is generally asymptomatic and no treatment is usually necessary, except for cosmetic reasons. The hair on the melanosis patch can be removed by using epilation creams, shaving, waxing or threading. Small melanosis lesions may be surgically removed. Different laser systems have been used to treat hypertrichosis and hyperpigmentation with highly variable results. Standard acne treatments may control acne in the lesion.
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Reference:
1.Book SE, Glass AT, Laude TA. Congenital Becker's melanosis with a familial association. Pediatr Dermatol. 1997 Sep-Oct;14(5):373-5.
2.Kar S, Preetha K, Yadav N, Madke B, Gangane N. Becker's nevus with neurofibromatosis type 1. Ann Indian Acad Neurol. 2015 Jan-Mar;18(1):90-2.
3.Issa G, Blalock TW, Lesher JL. Patient with giant Becker's nevus and epidermal nevus. Dermatol Reports. 2011 Sep 12;3(2):e23.
Image source: http://en.wikipedia.org/wiki/File:Becker-Naevus.jpg
Image author: Siller
Image licence: cc-by-sa-3.0
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Current topic in natural skin care: Beckers nevus - Becker's melanosis.
Get fair glowing skin complexion. Remove acne scars and blemishes from face.