{ "schema_version": 1, "kind": "condition", "id": "ingrown-toenail", "name": "Ingrown Toenail (Onychocryptosis)", "category": "infectious", "sources": "NICE Clinical Knowledge Summaries: Ingrown toenail 2022 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · No labelled dose - a procedure, not a medicine · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) · ARZOL Silver Nitrate Applicators (silver nitrate 75% / potassium nitrate 25%) DailyMed label, Indications and Application (SetID 23b83457-8cbc-26f1-e054-00144ff8d46c)", "review_status": "reviewed", "verified_against": "No labelled dose - a procedure, not a medicine · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · Ingrown Toenails - disease-level clinical article (ingrown-toenail-clinical.txt) · MSF Essential Drugs 2024 (ibuprofen oral monograph) · ARZOL Silver Nitrate Applicators (silver nitrate 75% / potassium nitrate 25%) DailyMed label, Indications and Application (SetID 23b83457-8cbc-26f1-e054-00144ff8d46c) · Ingrown Toenails - disease-level clinical article (ingrown-toenail-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1026, "generic": "Conservative nail management and warm soak", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Soak foot in warm water for 15-20 minutes 2-3 times daily; insert tiny cotton wick under corner of nail edge to elevate it above skin fold", "adult_duration": "1-2 weeks", "dose_source": "No labelled dose - a procedure, not a medicine", "rationale": "Mechanical elevation and proper trimming address the root cause; antibiotics are unnecessary in the absence of surrounding cellulitis or purulence", "cautions": [ "Cut toenails straight across, never curved into corners.", "Avoid tight-fitting footwear or high heels.", "Refer to minor surgery or podiatry if conservative care fails after 2 weeks or if severe granulation tissue develops." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Soak foot in warm water 15-20 min 2-3 times daily; ensure shoes have adequate toe room", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "ingrown-toenail" }, { "id": 1029, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Ingrown Toenails - disease-level clinical article (ingrown-toenail-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Recurrent or severe ingrown toenail needs referral for surgical matricectomy or phenolisation, which outperforms conservative and antibiotic management for preventing recurrence.", "RED FLAG - Diabetic or immunosuppressed patients should receive antibiotics even for minor infection - a lower threshold than the usual purulence or spreading-erythema trigger." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "ingrown-toenail" }, { "id": 1027, "generic": "Amoxicillin + Clavulanic acid", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 625.0, "adult_dose": "625 mg (500/125) three times daily for secondary skin fold infection with purulence or spreading erythema", "adult_duration": "7 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)", "rationale": "Co-amoxiclav covers the mixed skin and nail-fold flora usual in Egyptian primary care; flucloxacillin 500 mg QDS is an equally acceptable first choice where the infection is clearly staphylococcal.", "cautions": [ "Antibiotics alone will not cure ingrown toenail without removing mechanical pressure.", "Contraindicated in severe penicillin allergy.", "Check for underlying diabetes mellitus or peripheral arterial disease in elderly patients." ], "peds_mgkg_low": 25.0, "peds_mgkg_high": 45.0, "peds_max_mg": 1750.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "25-45 mg/kg/day (amoxicillin component) divided twice daily for 7 days", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 250, "high_mg": 450, "capped": false }, { "weight_kg": 20, "low_mg": 500, "high_mg": 900, "capped": false }, { "weight_kg": 30, "low_mg": 750, "high_mg": 1350, "capped": false }, { "weight_kg": 40, "low_mg": 1000, "high_mg": 1750, "capped": true } ], "brands": [ { "trade_name": "AUJED 625 MG 12 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 19.2, "pack_count": 12, "unit_price": 1.6, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "E-MOXCLAV 625MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXICLAVE 625 MG 12 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > NOVELL PHARMA", "price_egp": 37.5, "pack_count": 12, "unit_price": 3.12, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGNABIOTIC 625MG 8 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 37.0, "pack_count": 8, "unit_price": 4.62, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVIMOX 625 MG 12 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 107.0, "pack_count": 12, "unit_price": 8.92, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CURAM 625MG 12 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ > NOVARTIS", "price_egp": 108.0, "pack_count": 12, "unit_price": 9.0, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGMENTIN 625 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 117.0, "pack_count": 10, "unit_price": 11.7, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > ORGANOPHARMA", "price_egp": 31.5, "pack_count": null, "unit_price": null, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 156.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "ingrown-toenail" }, { "id": 1028, "generic": "Ibuprofen", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "400 mg three times daily after food PRN for pain and localized swelling", "adult_duration": "3-5 days PRN", "dose_source": "Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: \"The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period\". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): \"Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)\".", "rationale": "NSAID added to local nail care for pain and localised inflammation of an ingrown toenail; it treats the associated discomfort, not the anatomical problem itself, which may still need definitive nail-edge treatment.", "cautions": [ "Take with or after food to minimize gastrointestinal irritation.", "Avoid in active peptic ulcer, severe renal impairment, or third trimester of pregnancy.", "Caution in asthmatic patients with aspirin sensitivity.", "The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 10.0, "peds_max_mg": 400.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "5-10 mg/kg/dose three times daily after food PRN. Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day. Never exceed 400 mg in a single dose.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 300, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 400, "capped": false } ], "brands": [ { "trade_name": "DAJUANOFEN 400 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "COPAD PHARMA", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLABU 400MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 3.75, "pack_count": 10, "unit_price": 0.38, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 400MG 30 F.C. TABLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 12.75, "pack_count": 30, "unit_price": 0.42, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUPROFEN 400 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 6.0, "pack_count": 10, "unit_price": 0.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAFO 400 MG 30 F.C.TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEN 400 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 78.0, "pack_count": 30, "unit_price": 2.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROFUSOL 400MG 20 S.G CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ANALGIPROF 400 MG 25 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 37.5, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "ingrown-toenail" }, { "id": 1030, "generic": "Silver nitrate", "line": 2, "is_adjunct": true, "form": "topical", "strength_mg": null, "adult_dose": "Applied to the granulation tissue itself, and the label gives no schedule. What the label's APPLICATION section does say: the ARZOL applicator goes straight onto mucous membranes and other moist surfaces; on dry skin its tip is dipped in water immediately beforehand; and it is put carefully only on the area meant to be treated. It must NOT be used on the eyes. The applicator is silver nitrate 75% with potassium nitrate 25%. Neither the label nor the disease article states a number of applications or an interval, and none is invented here.", "adult_duration": "No duration is stated in either document. Apply once and review; the label's own warning about repeated use is in the cautions and is the limit that matters.", "dose_source": "ARZOL Silver Nitrate Applicators (silver nitrate 75% / potassium nitrate 25%) DailyMed label, Indications and Application (SetID 23b83457-8cbc-26f1-e054-00144ff8d46c)", "rationale": "The disease article names the drug and the tissue it is for: silver nitrate put on granulomatous tissue, to bring down hypergranulation and the heavy bleeding that comes with it. The product label's indications section names the same tissue - on skin it is put forward for cauterising wounds and indolent ulcers, and for taking off granulation tissue and warts. This is the same pairing already accepted on the umbilical-granuloma card and it is used here on the same basis. The card carried conservative nail care, an antibiotic and an analgesic, none of which touches the lump of granulation tissue that keeps the nail fold bleeding and weeping. Egypt registers no silver nitrate product at all, so no brand and no price can be shown - the applicators are clinic stock, not something the patient fills at a pharmacy.", "cautions": [ "IT IS A CAUSTIC. Label verbatim: \"Silver Nitrate is a caustic compound, the improper use of which may cause chemical burns. Silver Nitrate mixes with body fluids; this mixture is caustic and tissue damage may result if not removed quickly.\" Protect and dry the surrounding skin, and wipe away any run-off at once - the toe is wet with exudate, which is exactly how the burn spreads.", "REPEATED USE. Label verbatim: \"Long continued applications to large areas may produce argyria, a slate-blue discoloration of the skin and mucous membranes.\" Granulation tissue that has not settled after two or three applications is a reason to refer for definitive nail surgery, not to cauterise again and again.", "It blackens what it touches. Label verbatim: \"Silver nitrate blackens the tissues to which it is applied but this discoloration gradually disappears.\" Warn the patient, or they will think the toe has become gangrenous.", "NEVER USE IT ON THE EYES.", "It does not treat the ingrowing nail. The disease article's cautery sentence sits inside a list of non-surgical palliative measures; the definitive treatments on this card and in the article are nail care and surgery. Cautery removes the granulation tissue and leaves the cause.", "Infection is a separate question. The disease article gives antibiotics, by mouth or topically, where there is minor infection - cellulitis or an abscess alongside the nail - and where the patient carries a high-risk comorbidity such as diabetes or immunosuppression. A diabetic foot with a discharging nail fold is not a cautery problem.", "REGULATORY STATUS, STATED HONESTLY - this product is sold as an unapproved drug, and carries the FDA disclaimer that FDA has not established its safety or effectiveness. It is cited here only because it is the sole source found that describes how to apply the product; the indication itself comes from the disease article and the product's own indications section." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No strength, frequency, number of applications or maximum is stated for a child in either document, so no paediatric figure is printed. The label's neonatal warning is in the cautions and applies to thin skin generally. An ingrown toenail in a child is usually managed conservatively or surgically.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "ingrown-toenail" } ] }