General measures should also include management of the underlying factors (hyperhidrosis, onychomycosis). General measures for ingrown toenails include proper footwear as well as correct nail trimming this includes avoiding curved cutting off the lateral margins of the nail plate. Conservative measures are generally recommended in cases of mild to moderate lesions (stages 1 and 2), whereas severe lesions causing disability require surgical methods (stage 3). Indications for the treatment depend mainly on the stage of the condition, prior modalities of treatment in case of recurrence, and other factors including allergies to local anesthetics, pregnancy, and bleeding disorders. Treatment methods for ingrown toenails range from medical measures to surgical interventions. However, more recent reports suggest no difference in anatomical abnormalities between patients with ingrown toenails and controls. Other studies proved that bone abnormalities that increase the internal pressure, in the ankle, foot, or toe, might play a role in the development of ingrown toenails. Some studies have found that pincer-nail deformity, wide nail plates, congenital malalignment of the toenails, and thickening of the nail plate represent possible risk factors for ingrown toenails. The possible involvement of intrinsic risk factors in the pathogenesis of ingrown toenails, such as abnormal nail shape and anatomical abnormalities, has been widely debated. Other predisposing factors for ingrown toenails include tight-fitting shoes, bad foot hygiene, hyperhidrosis, trauma, and the use of some medications, especially epidermal growth factor receptor inhibitors (gefitinib, cetuximab). Improper nail trimming appears to be the most common etiology of ingrown toenails as it may lead to a nail spike that traumatizes adjacent soft tissue.
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