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Avoid cutting corners in nail care

The simple removal of a corner of a nail can set off a vicious cycle that eventually results in chronic nail infections. Nail growth occurs from a "c" shaped region of cells occuring below the skin line (as seen on side view of nail). It is therefore these cells that ultimately determine the width of the nail itself.

This well intentioned initial wedge marked as (a) in the top view of a nail generally provides temporary relief. However, this does not change the growth pattern of the nail itself. Within a month or two an even larger piece must be removed (marked b). At some point it is difficult to keep up as the skin quickly learns to respond to the pressure of ingrowing nails. The skin response referred to as granulation tissue becomes nature's protection against the invasion of the offending nail.

At some point the skin becomes so reactive that granulation tissue can cover a large portion of the nail itself. At this stage the pain and skin response becomes too great for the patient to self manage.

Certainly, local soaks and antibiotics do provide some temporary measure of relief until further nail regrowth occurs. Another commonly attempted solution is total nail removal. This also puts the problem off for some time, but generally guarantees that now both borders will become ingrown.

The folk medicine suggestion of cutting a 'v' in the middle of the nail gives the impression that the nail comes together as it grows out. Again, the nail bed controls the pattern of nail growth and the resolution of the 'v' is somewhat of an 'optical' delusion.