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Abstract: The patient, a 21-year-old college student who loves sports, presented to the clinic with a mildly painful perinail redness and swelling around the first toe of the left foot for more than 2 months, and was diagnosed with chronic onychomycosis associated with an ingrown nail. The patient was given medication and physical therapy, and was advised to walk less and wear loose shoes recently.
Basic information】Male, 21 years old
Disease Type】Chronic nail fungus
Hospital】Guangdong Provincial People’s Hospital
Date of Consultation】March 2022
Treatment plan】Oral medication (cefuroxime capsule) + topical medication (povidone-iodine solution, compound polymyxin B ointment) + physical therapy (infrared irradiation)
Treatment period】Outpatient treatment for 2 weeks, review after 1 month
Treatment effect】Local redness, swelling and pain completely disappeared, and the ingrown nail phenomenon has improved.
I. Initial consultation
The patient is a 21-year-old male, a college student, who loves sports. He has had redness and swelling around the first nail of his left foot for more than 2 months, with mild pain, which does not affect walking. The degree of redness and swelling was sometimes mild and severe, and sometimes there was yellow mucus exudation. On examination of the patient’s skin, he saw redness and swelling in the perineal area adjacent to the medial edge of the first toenail of the left foot, with a thick yellow crust covering the nail groove area, painful pressure, and a trace of yellow fluid exuding. There was no abnormality such as yellowing, deformation or cloudiness of the nail plate. The patient said that initially the nail groove was mildly painful, and that it got better after cutting the toenail as short as possible, but later the corner of the toenail always stuck into the flesh, and the nail groove area became red and swollen, which became more and more serious.
II. Treatment history
The patient’s secretion was negative for fungal microscopy. There were signs of local infection, and cefuroxime capsules were given orally for 1 week, together with daily external rubbing of povidone-iodine solution for disinfection followed by topical application of compound polymyxin B ointment, combined with infrared radiation physiotherapy. At the same time, we communicated with the patient and advised to avoid sports and excessive walking in the near future, pay attention to local hygiene, wear loose shoes, and do not trim the toenail in the area for the time being.
III. Treatment effect
After 2 weeks of standardized treatment, the patient’s toe redness and swelling subsided significantly, and his complaints of pain subsided significantly. The patient was advised to insert cotton shallowly into the gap between the nail and the flesh to alleviate the ingrown nail phenomenon and facilitate recovery. 1 month later, the local redness, swelling and pain had completely disappeared and the ingrown nail phenomenon had improved.
IV. Precautions
We are glad that the patient’s chronic nail infection was effectively treated, but we need to advise the patient not to wear shoes that are too tight, to pay attention to local hygiene, and to trim the toenails correctly, avoiding trimming them too short to avoid recurrence of the nail infection. If the ingrown nail becomes severe and difficult to relieve or if there is severe granulation tissue growth in the future, you need to go to the hospital for nail extraction or partial nail removal surgery in time.
V. Personal insight
Chronic onychomycosis associated with ingrown nails is very common. In this article, the pain caused by onychomycosis in the early stages was not significant and did not affect walking, so it was ignored and was only seen when the symptoms became severe. For chronic onychomycosis, in addition to clinical treatment, it is important not to wear shoes that are too tight, not to exercise strenuously when early symptoms appear, and to pay attention to local hygiene and avoid prolonged humidity. The correct way to trim a toenail is to flatten the edge of the nail and let the nail grow forward.