# Ingrown Toenail (Onychocryptosis) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Conservative nail management and warm soak - Referral & safety-netting (no drug therapy) - Amoxicillin + Clavulanic acid — 625 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Silver nitrate — topical ## Complete treatment card ```text INGROWN TOENAIL (ONYCHOCRYPTOSIS) 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 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) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Pain along the side of the nail worsens with footwear, walking or direct pressure - A history of improper nail trimming, recent trauma, repetitive sport activity or tight shoes is common - Pus discharge or a bad smell signal secondary infection in advanced cases [pus] SIGNS - what you find (3) - Tenderness along the nail border with the nail plate visibly cutting into the surrounding soft tissue is the key exam finding - Granulation tissue and thickening of the nail fold with wound drainage mark more advanced disease [wound discharge] - Staging runs from mild redness and swelling without pus, to inflammation with drainage, to chronic granulation tissue with fold thickening [redness] TESTS (3) - Diagnosis is usually made clinically; culture or an x-ray is reserved for suspected deeper soft-tissue or bone infection - An x-ray can rule out an underlying bony growth beneath or beside the nail when its shape looks abnormal - MRI is reserved for cases where an x-ray suggests bone changes consistent with underlying bone infection IF NOT THIS - what else fits (3) - Ski-jump hallux, subungual exostosis and osteochondroma are structural mimics to consider - A subungual bone tumour or old trauma with hypertrophic remodeling can be confirmed when an x-ray shows bony proliferation beneath the nail - Locally aggressive mimics to keep in mind include subungual melanoma, its amelanotic form, and subungual squamous cell carcinoma Source StatPearls "Ingrown Toenails" - disease-level clinical article Status traced to the source above Rx: Main treatment | Chemical cautery of hypergranulation tissue - a procedure, not a prescription MAIN TREATMENT - choose one, plus any add-on marked below 1. CONSERVATIVE NAIL MANAGEMENT AND WARM SOAK [1st line] Adult 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 x 1-2 weeks Peds Soak foot in warm water 15-20 min 2-3 times daily; ensure shoes have adequate toe room Source No labelled dose - a procedure, not a medicine Why Mechanical elevation and proper trimming address the root cause; antibiotics are unnecessary in the absence of surrounding cellulitis or purulence Caution 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. 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Ingrown Toenails - disease-level clinical article (ingrown-toenail-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution 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. 3. AMOXICILLIN + CLAVULANIC ACID [2nd line] Adult 625 mg (500/125) three times daily for secondary skin fold infection with purulence or spreading erythema x 7 days Peds 25-45 mg/kg/day [child max 1750 mg] (25-45 mg/kg/day (amoxicillin component) divided twice daily for 7 days) 3kg -> 75-135 mg/day 4kg -> 100-180 mg/day 5kg -> 125-225 mg/day 6kg -> 150-270 mg/day 7kg -> 175-315 mg/day 8kg -> 200-360 mg/day 9kg -> 225-405 mg/day 10kg -> 250-450 mg/day 11kg -> 275-495 mg/day 12kg -> 300-540 mg/day 13kg -> 325-585 mg/day 14kg -> 350-630 mg/day 15kg -> 375-675 mg/day 16kg -> 400-720 mg/day 17kg -> 425-765 mg/day 18kg -> 450-810 mg/day 19kg -> 475-855 mg/day 20kg -> 500-900 mg/day 21kg -> 525-945 mg/day 22kg -> 550-990 mg/day 23kg -> 575-1035 mg/day 24kg -> 600-1080 mg/day 25kg -> 625-1125 mg/day 26kg -> 650-1170 mg/day 27kg -> 675-1215 mg/day 28kg -> 700-1260 mg/day 29kg -> 725-1305 mg/day 30kg -> 750-1350 mg/day 31kg -> 775-1395 mg/day 32kg -> 800-1440 mg/day 33kg -> 825-1485 mg/day 34kg -> 850-1530 mg/day 35kg -> 875-1575 mg/day 36kg -> 900-1620 mg/day 37kg -> 925-1665 mg/day 38kg -> 950-1710 mg/day 39kg -> 975-1750 mg/day (upper capped) 40kg -> 1000-1750 mg/day (upper capped) 41kg -> 1025-1750 mg/day (upper capped) 42kg -> 1050-1750 mg/day (upper capped) 43kg -> 1075-1750 mg/day (upper capped) 44kg -> 1100-1750 mg/day (upper capped) 45kg -> 1125-1750 mg/day (upper capped) 46kg -> 1150-1750 mg/day (upper capped) 47kg -> 1175-1750 mg/day (upper capped) 48kg -> 1200-1750 mg/day (upper capped) 49kg -> 1225-1750 mg/day (upper capped) 50kg -> 1250-1750 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) Why 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. Caution 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. Egypt AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) E-MOXCLAV 625MG 10 TAB. EIPICO 30.00 EGP (3.00/unit) DEXICLAVE 625 MG 12 F.C. TABS. RAMEDA > NOVE... 37.50 EGP (3.12/unit) MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) CLAVIMOX 625 MG 12 F.C.TABS. PHARCO 107.00 EGP (8.92/unit) CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 31.50 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 4. IBUPROFEN [add-on - not a substitute] Adult 400 mg three times daily after food PRN for pain and localized swelling x 3-5 days PRN Peds 5-10 mg/kg/dose [child max 400 mg] (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.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) 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)". Why 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. Caution 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. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid CHEMICAL CAUTERY OF HYPERGRANULATION TISSUE - A PROCEDURE, NOT A PRESCRIPTION - give alongside 5. SILVER NITRATE [add-on - not a substitute] Adult 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. - 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. Peds 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. Source ARZOL Silver Nitrate Applicators (silver nitrate 75% / potassium nitrate 25%) DailyMed label, Indications and Application (SetID 23b83457-8cbc-26f1-e054-00144ff8d46c) Why 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. Caution 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. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)