Infected Toenail Treatment

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Infected Toenail

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Before you start a diagnosis, please read all of the information below.

An ingrowing toenail is a common condition which may cause discomfort or become infected. It is where the side of the nail cuts into the surrounding skin. The skin may become red, inflamed and painful. Bacteria can sometimes enter the broken skin leading to an infection. This can cause crusting, weeping, and pus to develop around the side of the nail.

Any toe can be affected, but it is usually the big toe. It is a common problem, especially among teenagers and young adults.

 

Please see the 'Common Treatments' section below for further information.


Common Symptoms

  • a painful toenail
  • weepy discharge from the skin around the nail
  • localised redness affecting the toe
Common Treatments

Speak to your pharmacist for advice on over the counter treatments that may help such as antiseptic creams and painkillers.

If your ingrowing toenail becomes infected then you may require antibiotics.

Possible treatments we prescribe if clinically appropriate:


*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

Please click on the medication above to read the Patient Information Leaflet for important information about each drug. We use national prescribing guidelines to select which treatment would be most appropriate for your condition. 

Risk factors

Various factors can increase your risk of developing ingrowing toenails. These include:

  • not cutting your toenails correctly
  • tight footwear
  • sweating a lot 
  • nail deformities
  • nail injury
  • fungal nail infection

To help prevent an ingrown toenail from developing, avoid tight fitting shoes, air your feet as much as possible, wear cotton and not synthetic socks and keep your feet clean and dry. Ensure you cut your nails straight across and not short or rounded at the edges. 

Self-help

You may be able to treat an ingrowing toenail in its early stages at home if it is not infected.  

  • Soak your foot in salt water for 10 minutes
  • Using a cotton wool bud push the skin fold over the ingrown nail away from it.
  • Push a small piece of rolled cotton wool or dental floss under the nail to help it grow over the skin and not into it.
  • Repeat the above daily until the nail has grown away from the skin. Once the nail has grown then cut it straight across and not rounded at the corners.
Information about flucloxacillin

The antibiotic Flucloxacillin can be used to treat an infected toenail if you are not allergic to penicillins. Before you start treatment, always read the manufacturers leaflet contained with the medication. This contains more information and lists all the potential side effects.

The dose is to be taken four times a day, it is important that you space out the doses evenly during the day. Swallow the capsule with water, and take it on an empty stomach. This means an hour before food or 2 hours after food. 

Do not take Flucloxacillin if you are allergic to Penicillin.

Keep taking Flucloxacillin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never give your medication to other people even if their condition appears to be the same as yours.

Possible side effects to flucloxacillin

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist. 

The most common ones for Flucloxacillin include:

  • feeling sick (nausea) or vomiting
  • diarrhoea
  • redness and itching in the mouth or genital area (thrush)
  • a skin rash
Information about clarithromycin

The antibiotic Clarithromycin can be used to treat an infected ingrowing toenail if you are allergic to penicillins. Before you start treatment always read the manufacturers leaflet contained with the medication, which contains more information and the potential side effects.

The dose is to be taken twice a day; it is important that you space out the doses evenly during the day. Swallow the tablet with water, and you can take Clarithromycin either before or after your meals.

Keep taking Clarithromycin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never give your medication to other people even if their condition appears to be the same as yours.

Possible side effects to clarithromycin

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist. 

The most common ones (occur in about 1 in 10 people) for Clarithromycin include:

  • feeling sick (nausea) or vomiting
  • diarrhoea
  • redness and itching in the mouth or vagina (thrush)
  • tooth or tongue discolouration, and changes in the way things taste or smell. This will settle once you finish treatment.
  • a headache
Who should not take Clarithromycin

It is important that you tell your doctor in your assessment of all the medical conditions you have, and all the medications you take. Failure to do so can lead to problems with any treatment you are prescribed. Always read the patient leaflet before you take any medication. 

The following groups of people should not take Clarithromycin:

  • those allergic to clarithromycin or macrolide antibiotics
  • those with QT prolongation or ventricular cardiac arrhythmia, including torsades de pointe
  • those with heart disease
  • those with hypokalaemia (low potassium)
  • those with problems with the way your liver works
  • pregnant women or if breastfeeding 

The following medications can interact with Clarithromycin:

  • Statin for lowering cholesterol: you should stop your statin while you are taking Clarithromycin.
  • Colchicine used for gout: clarithromycin should not be taken if you are also taking colchicine. 
  • Warfarin: Clarithromycin can increase the bleeding risk
  • Ergotamine or dihydroergotamine used for migraines: Clarithromycin must not be taken with them
  • Sildenafil, tadalafil or vardenafil: Clarithromycin can increase the levels of the erectile dysfunction (ED) medication in the body. Consider reducing the dose of the ED medication while taking Clarithromycin. 
Allergic reactions to medication

An itchy rash, swollen face or mouth, or difficulty in breathing, may be signs that you are allergic to the antibiotic. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. For Medical Emergencies please call 999.

If you develop a sudden onset of any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance using 999 or go to A&E if the symptoms are severe.

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips
  • A rash particularly if affecting your entire body
When to seek further medical advice

If you develop any of the following symptoms, then it is important to seek medical advice as soon as possible:

  • If you develop a persistent high fever (high temperature) which can cause shivers.
  • If the pain becomes worse.
  • If you feel increasingly unwell (this may include nausea and vomiting).
  • If you develop spreading redness affecting your skin around the site of your infection.
  • If you develop any painful, red and hot joints near to the infection.

If you develop any of the following symptoms, then you must seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111). Call an ambulance using 999 or go to A&E if the symptoms are severe.

  • drowsiness or confusion
  • difficulty in breathing or shortness of breath
  • a severe headache
  • if you develop redness, swelling and warmth around the eye
  • if you are unable to look at bright lights (photophobia)
  • chest pain
  • persistent vomiting
  • neck stiffness
  • non-blanching rash
Complications

If an ingrowing toenail does not improve then you may require surgery to treat it. This can involve either a partial nail avulsion or a total nail avulsion. 

A partial nail avulsion is where the edges of the toenail are cut away after an injection of local anaesthetic into the toe. 

A total nail avulsion is where the full nail is removed. This is usually done when the nail has thickened making a partial nail avulsion difficult. 

Sometimes an infection of the ingrowing toenail may spread causing a cellulitis. This will usually cause a spreading redness affecting the skin of the foot, which feels hot and tender. 

Antibiotic Resistance

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

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