Ingrown toenails: causes, symptoms and remedies
Dott. Simone Gabbanini
What are ingrown toenails?
Onychocryptosis (from the Greek hidden nail) commonly called ingrown nail, is a painful condition that occurs when the edges or corners of the nails grow into the skin near the nail. This causes swelling and pain and can lead to an infection of the edge of the nail which can spread to the skin and bone. It is a fairly common disorder and is estimated to affect 2 to 5% of the population. It generally occurs in the feet, rarely in the hands, and the finger most prone to this pathology is the big toe.
What are the causes of ingrown toenails?
The causes that favor the onset of ingrown toenails are many. One of the main ones is the incorrect way in which toenails are cut. In fact, it has been shown that smoothing the nails laterally, rather than leaving a straight edge, promotes their growth inside the skin, tearing it and causing infection.
Other factors that help the onset of the phenomenon are:
- Using too tight footwear that puts a lot of pressure on the big toes
- Irregular, thickened and curved nails (frequent in old age)
- Bad posture
- Injuries such as falling heavy objects on the toenail
- Repeated trauma such as running sports, or repeatedly kicking a soccer ball
Another non-negligible cause is improper hygiene such as, for example, not keeping the feet clean and dry, especially in the case of excessive sweating, a condition that often occurs in adolescents.
How does the ingrown toenail manifest itself? And what are the symptoms?
It is not entirely clear whether the determining event is abnormal nail growth inside the skin, or whether it is an excessive proliferation of the skin in contact with the lateral surface of the nail.
In any case, the result is too close contact between the nail and skin fold, resulting in a painful manifestation that increases if you walk or wear shoes. Initially, the affected finger is swollen and red. If the inflammation lasts for a long time, skin hardening, bacterial infection with discharge of purulent material and the formation of excess crust granulation tissue may develop.
How are ingrown toenails diagnosed?
The ingrown toenail is easily recognizable by the podiatrist, so the diagnosis is extremely simple. Only in some cases may an x-ray be necessary to show how deep the nail has grown into the skin. An x-ray can also reveal, if the ingrown toenail was caused by an injury, that there are no fractures in the bones of the foot.
How to cure an ingrown toenail?
Turning to professionals and avoiding DIY is certainly the best way to go, however, based on the severity of the condition, two lines of treatment can be followed:
- In less severe cases when the problem is superficial and there is no pain or pus, the treatment is mostly conservative and involves numerous foot baths in very hot water, the daily application of an antibacterial, wearing loose or open footwear, cutting nails correctly, avoiding rounding the edges, treating excessive sweating or any onychomycosis. You can also exert traction through the use of gauze on the nail plate in order to distance the edge of the nail from the skin and thus reduce pressure and pain.
- When the ingrown nail grows deeply into the skin, creating infection, pain and other complications, it is necessary to resort to an avulsion operation, i.e. partial or total surgical extraction of the nail plate, or removal of the excess skin overlying the lateral nail fold. reducing the pressure on the nail.
How can it be prevented?
The useful tips to prevent the onset of ingrown nails are the same as those to be implemented in the case of onychocryptosis already present. One of the best is undoubtedly to cut your nails correctly, so avoid shortening them too much and make a horizontal cut, never rounded.
Other useful behaviors and precautions consist in wearing comfortable and not too tight footwear, maintaining proper personal hygiene by washing your feet daily, drying them carefully and changing socks frequently. Prefer socks in natural and breathable fabrics, avoiding if possible those in synthetic fabrics.
Daily foot hygiene is certainly a very useful practice in the prevention of ingrown toenails.
In particular, four products studied in the BeC laboratories have proved to be extremely effective in the treatment of this condition and lend themselves to being included in a routine of daily use:
Run a foot bath for about 10 minutes with very hot water in which you have added Liquido Sanitizzante L.S. This product, thanks to the presence of precious essential oils such as Lavender, Thyme and Lemon, has a profound antiseptic action.
After thoroughly drying your feet, use a few drops of Olio Essenziale di limone with a high antifungal and anti bacterial action to prepare the skin for the action of the next treatment.
Apply the Crema Balsamo C.R.B. to the affected area. with soothing and anti-inflammatory action thanks to the presence of essential oil of Matricaria Chamomile.
Apply Crema C.R.P. all over the foot for a feeling of freshness and relief.
Cyclooxygenase, lipoxygenase and the inflammatory process
Cyclooxygenase and lipooxygenase are the two families of enzymes that are commonly involved in the inflammatory process, through a complex of reactions which is called arachidonic acid cascade. This complex of reactions develops as follows: a first enzyme, a phospholipase cleaves the phospholipids of biological membranes, releasing arachidonic acid, a polyunsaturated fatty acid with 20 carbon atoms (eicosa-5Z,8Z,11Z,14Z-tetraenoic acid ; C20:4; ω-6). The arachidonic acid is then transformed by two parallel enzymatic pathways, that is, by two families of enzymes: the cyclooxygenase which transforms it into prostaglandins and thromboxanes and the lipooxygenase which transforms it into hydroperoxides which in turn transform into leukotrienes .
There are two cyclooxygenase isoforms indicated with type 1 and type 2, briefly COX-1 and COX-2. COX-1 is the enzyme present in most cells (except red blood cells), and is constitutive, that is, it is always present. COX-2 is an inducible cyclooxygenase isoform: it is constitutively present in some organs such as brain, liver, kidney, stomach, heart and vascular system, while it can be induced (i.e. developed if necessary) following inflammatory stimuli on the skin, white blood cells and muscles.
There are various types of lipooxygenase that lead to different products, the most important in the inflammatory process is 5-lipooxygenase, 5-LOX.
Prostaglandins, Thromboxanes, and Leukotrienes
Prostaglandins, Thromboxanes, and Leukotrienes are chemical messengers or mediators, that is, molecules that bring a message to specific cells and activate or deactivate metabolic responses in these cells. They, therefore, have a function similar to hormones, only that, unlike what hormones do, the chemical message is carried only at a short distance, that is, only to the cells that are in the vicinity of the place where the mediators were produced. There are different prostaglandins, different thromboxanes and different leukotrienes that carry specific messages. In many cases these act as mediators of the inflammatory process , therefore they trigger all the events that are involved in inflammation:
– vasodilation with consequent blood supply (redness),
– increased capillary permeability with consequent fluid exudation (swelling or edema),
– stimulation of nociceptive nerve signals (pain),
– on-site recall of immune system cells that attack a possible invader (chemotactic action)
– activation of the biosynthesis of fibrous tissue to strengthen or repair the affected part (even if there is no need)
– generations of free radicals that can chemically destroy an invader (but also damage our tissues, i.e. they just “shoot in the middle”).
Prostaglandins and thromboxanes, however, also play important physiological roles in normal conditions, i.e. in the absence of inflammation. For example, they regulate the secretion of mucus that protects the walls of the stomach, they regulate the biosynthesis of cartilages and synovial fluid in the joints, they regulate vasodilation, hence the correct flow of blood in the various local districts, and more.
Triglycerides are the main components of most oils and fats. These are heavy, non-volatile and little polar molecules, insoluble in water, made up of glycerol (or glycerin) esterified with three molecules of fatty acids: therefore, it is a tri-ester of glycerin, from which the name derives. Each fatty acid contains 8 to 22 carbon atoms (commonly 16 to 18) and can be saturated, mono-unsaturated or poly-unsaturated. The size of the fatty acids and their saturation determines the physical and sensorial properties of the triglycerides, which can appear as oils (liquids at room temperature) or fats (solid or semi-solid) and can have greater or less greasiness and smoothness on the skin. Unsaturated triglycerides or with shorter fatty acids are more fluid and have greater flowability.
Fatty acids (saturated, mono-unsaturated and poly-unsaturated)
The name fatty acids is commonly used to indicate those organic acids that are found in the composition of lipids, that is, in animal and vegetable oils and fats, both in the free form and in the form of esters with glycerol (e.g. in triglycerides), or they are esterified with “fatty” alcohols, that is, long chain alcohols, to form waxes. Fatty acids are carboxylic acids (formula R-COOH) which have a long carbon chain (R), unlike common organic acids such as acetic acid and propionic acid, which have 2 or 3 carbon atoms in total, respectively. Fatty acids are defined as saturatedif they do not have double carbon-carbon bonds, (called “unsaturations”), they are defined mono-unsaturated if they have only one, they are defined mono-unsaturatedpoly-unsaturated if they have two or more double bonds (see figure). The term omega-3 (ω-3) or omega-6 (ω-3), refers to the position of the first double bond starting from the bottom of the chain of carbon atoms: if the first double bond is encountered after 3 carbon atoms the fatty acid is classified as omega-3 , if after six carbon atoms omega-6 , as shown in the figure. The most common saturated fatty acids are palmitic acid (16 carbon atoms and no double bond, C16: 0) and stearic acid (18 carbon atoms, 18: 0), the most common mono-unsaturated is the oleic acid, typical of olive oil (18 carbon atoms and 1 double bond in position 9, C18: 1; ω-9), while the most common poly-unsaturated are linoleic acid and linolenic acid, progenitors respectively omega-6 and omega-3 (see figure).
Terpenes and terpenoids
Terpenes or terpenoids are a large family of natural molecules, typically containing 10 to 30 carbon atoms, which are biosynthesized from a common “brick”, isopentenyl pyrophosphate (IPP), containing 5 carbon atoms (see figure). The discovery that the repetitive brick consists of 5 carbon atoms is relatively recent, while it was once assumed that the entire family was created by repeating a brick of 10 carbon atoms, which was called “terpene”. Therefore, the molecules with 10 carbon atoms (such as limonene, see figure) were called mono-terpenes, i.e. composed of a single brick, diterpenes those with 20 carbon atoms (e.g. the cafestol that gives the aroma to the coffee), triterpenes those with 30 carbon atoms (e.g. beta-carotene). Since molecules made from 15 carbon atoms were also found (such as bisabolol), it was thought they contained a terpene and a half, and were called sesquiterpenes (from the Latin semis = half + atque = and). Today it is known that the repetitive unit is composed of 5 carbon atoms, therefore it is easy to understand how mono-terpenes contain two (see figure), sesquiterpenes three, diterpenes four, triterpenes six.