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the ingrown toenail is a common problem which occurs mostly in the first toe and causes a high amount of morbidity in affected patients . in this report
we document a strange case of ingrown toenail of the first toe , which had developed as a huge mass and enveloped the nail .
we describe here the cauterization of the nail matrix with phenol after surgical resection of the tumor , a treatment that had good results .
a 56-year - old man came to our office complaining of pain , offensive smelling discharge and disappearance of the nail of the right great toe . physical examination showed epithelized mass on the nail plate and fistulation from the proximal nail fold to the tip of the toe
, epithelization did not occur on the nail plate side of the mass ( figure 1 ) .
the clinical diagnosis of this tumor was epithelized granulation tissue caused by ingrown toenail , however squamous cell carcinoma was not denied completely .
photograph shows epithelized granulation tissue on the nail plate and fistulation from the proximal nail fold to the tip of the toe the operative treatment involved anesthetizing the toe with a digital nerve block using 1% lignocaine .
the tumor mass was excised at the bilateral terminal base point , and was sent to pathology for an immediate diagnosis .
the pathological finding was granulation tissue with partial scar formation , and the external surface of the tumor was covered with epithelial cells .
next , the nail plate was incised longitudinally from top to the root at a width of approximately 5 mm .
the posterior nail fold and the nail matrix were cauterized completely with an 88% phenol - immersed cotton - tipped applicator for five minutes .
the excessive skin and soft tissue of the tip of the toe were excised and trimmed ( figure 2 ) .
bilateral chemical matricectomy of the matrix was done with phenol after resection of the tumor eighteen months after the operation , there is no recurrence of the ingrown toenail ( figure 3 ) .
ingrown toenail deformity is a common nail pathology that causes intractable pain and discomfort , hindering normal walking and markedly decreasing the quality of life of patients .
ingrown toenails could be a cause of granulation tissue of the lateral nail fold of the finger or toe ( 1 ) .
however , an ingrown toenail creating such a huge mass on the nail plate , as in this case , is very rare . in the literature , to our knowledge , there have been no reports of cases similar to our patient . in the case presented here , the patient had treated his ingrown toenail himself for one year with an ointment purchased over the counter before he came to our office .
however the granulation tissue of both sides of the nail had increased gradually and advanced on the nail plate in the medial direction . finally , the granulation tissue from both sides adhered and epithelial cells advanced over the granulation tissue completely .
conservative and surgical forms of therapy for ingrown nails have been used , however , there is no common or unique form of treatment ( 26 ) . in recent years , matrix phenolization of the nail bed has been used increasingly , and has been reported to give less discomfort and lower recurrence rates ( 7,8 ) .
the procedure of phenolization is easy to perform and does not require specialized equipment ( 9 ) . in our reported case ,
after resection of the epithelized granuloma , both sides of the posterior nail fold and the nail matrix were cauterized completely with phenol . after this simple treatment
the only disadvantage of the treatment was the smallness of the toenail , however , the patient did not complain of this aesthetic disadvantage due to the advantages of freedom from pain and the bad odour .
we experienced a strange case of ingrown toenail , which had developed as a huge mass and enveloped the nail of the left first toe . 
 the patient had self - treated his ingrown toenail for a period of one year with an ointment available over the counter . 
 however , the granulation tissue on both sides of the nail had increased gradually and advanced over the nail plate in the medial direction . 
 finally , the granulation tissue on both sides had adhered to the nail and epithelial cells advanced over the granulation tissue completely . during surgery , the epithelized granulation tissue was excised at the bilateral terminal base point , and the posterior nail fold and the nail matrix were cauterized completely with phenol . 
 eighteen months after the operation there was no recurrence of the ingrown toenail .