Skin Republic

Dear Dr. Jen,

I have an ingrown toe nail.  What are the ways to get rid of it permanently?  It’s been bothering me a lot.  I went to a salon to get rid of it, but it grows back again.  Can you please help me about this problem?

Maricris

Dear Maricris,

Ingrown toe nails occur when edges of the toe nail grow and bite into the side nail beds.  This is caused by many things, but the more common cause is when the nails are cut too short on the side.  It boggles my mind why most manicurists prefer to cut and file the toe nails like the shape of a pyramid, making it susceptible to infections and in-growns.  Other causes include using tight foot wear or concomitant fungal nail infections.

First thing you have to do is check for redness, inflammation, pus and pain in the area.  If this is so, then I don’t think salon visits are enough; you may have to go to a PDS dermatologist for some antibiotics and anti-inflammatories. 

If infection is absent, then you can start by soaking your affected foot in some warm (not hot) salted water. You might have to wear open toed shoes for the next couple of weeks. Most importantly, cut your toe nails straight across and avoid using a nipper to cut the sides of the nails.

If conservative management hasn’t improved it, then there are several things your dermatologist can do.  One is to insert wisps of cotton into the sides to prevent it from biting the skin and wait for the swelling of the surrounding skin to subside.  Nail bracing can also be utilized but this is rather tedious to do.  Or else, surgical intervention can be done by damaging the matrix of the nail, only the sides, so that it will never grow too long to bite into the skin.  Or if your derma or surgeon prefers, excising or chemically destroying the protruding skin bulge can also be an option. Either way, if infection has already set in, do not attempt to do surgery at home; seek professional help.

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Dear Dr. Jen,

I have painful pimples on my scalp every now and then.  My docs have been putting me on antibiotics every time and it does go away. But it keeps coming back after a period of time.  Is there a permanent cure to my condition?  It becomes very painful when the pimples get big, especially when I’m lying down or when it gets hit by a comb.

Christie

Dear Christie,

Recurrent scalp acne is very uncomfortable.  Usually, it can be cured by shampooing with salicylic acid or anti-fungal based products.  For the more serious, recurrent scalp folliculitis, you might need to head over to your PDS derm to get a more thorough check on the matter. 

Although your doctors were doing the right thing in treating it with antibioticsintitially, there are other things to take into consideration.  First of all, if it keeps coming back, then you might need to have the kind of bacteria that resides in the acne identified by having a culture and sensitivity done. 

Secondly, if oiliness in the scalp is the source of the problem and not bacteria, then you might have to be given oral isotretinoin on a long-term basis.  Oral isotretinoin can be a cure to over-active oil glands.  This is a vitamin A derivative that needs a healthy liver to process the medication.  Also, you cannot get pregnant while taking this medicine.  You can get a more detailed explanation about this medicine from your doctor.  Best of luck!