frequent topical antibiotics: triple antibiotic? iodine? chlorhexidine?

October 22, 2014 9:32 PM

What are the odds that applying triple antibiotic ointment every month is going to breed antibiotic-resistant bacteria on my skin? I also have access to iodine and chlorhexidine. Would it help to use one of those instead? Or maybe rotate between them?

I have an ingrown toenail that sometimes gets inflamed and tender. A few times a year, it won't resolve with a few nights of saltwater soaking, and then I apply some triple antibiotic ointment daily for two or three days. At this point, I expect to have to do this for the rest of my life.

Other ingrown toenail advice is also welcomed.

posted by d. z. wang to Science & Nature (15 answers total)

Other ingrown toenail advice is also welcomed.

Have you considered surgery?
posted by Sys Rq at 9:36 PM on October 22, 2014 [1 favorite]

If you can take off a long weekend, have it cut out on a Thursday or Friday, and rest the foot over the following 4-5 days. You'll feel so much better, trust me.
posted by a lungful of dragon at 9:37 PM on October 22, 2014

Response by poster: Uh, to be clear, it is completely asymptomatic for weeks at a time and has never interfered with my regular activities. Surgery seems a little eager here.
posted by d. z. wang at 9:42 PM on October 22, 2014

FYI, "surgery" is just done in the doctors room with local, they cut out a teensy bit of the nail bed and put in like two stitches, totally not a big deal and takes about fifteen minutes. I've had it done, but in grown toe nail incidence also reduced when I wore shoes with bigger toes and, crucially, started cutting my toe nails in a u shape, ie with the longest parts at the edges not following the triangle shape nails naturally grow in. recommended, and best of luck.
posted by smoke at 11:09 PM on October 22, 2014 [3 favorites]

I have frequently been impressed by the effects of anti-haemorrhoid cream (the kind consisting of zinc oxide in grease plus a topical anaesthetic) applied to swollen inflamed things that aren't haemorrhoids. In particular, it worked well for me as a followup to hot salt water soaks, for a recent inflammation in a toenail growing back after a crush-and-tear injury.

The grease is fairly thick and hard to shift, so it's good for keeping the tender bits clean after the soak; the zinc oxide is a mild astringent, and tends to take the swelling down; and the lidocaine takes the edge off the soreness quite well. It isn't any kind of antiseptic, apart from forming a physical barrier to re-inoculation, so I can't see it having resistance-promoting effects with repeated use.
posted by flabdablet at 1:53 AM on October 23, 2014 [1 favorite]

Seconding Smoke, the "surgery" is trivial. I've done it twice. Slightly sore for a day, no stitches even, just a bandage. Instant relief from years of what you've described.
posted by JimN2TAW at 2:12 AM on October 23, 2014 [3 favorites]

Thirding. Just get it taken care of. In office procedure, sore for a few days, no more hassle. At least go TALK to a podiatrist about it (then you can ask your antiB question too).
posted by PorcineWithMe at 3:24 AM on October 23, 2014 [1 favorite]

I had ingrown toenails all through my childhood, and all a podiatrist told us was that I'd have to have surgery when I was older. I was all set to have the surgery in my early teens but the surgeon had me try wicking, and lo and behold my ingrown toenail was fixed. I only had to clear a few ingrown toenails this way, and my nails haven't gone ingrown or infected since then.

If you'd like to try wicking: After a saltwater soak, take a cotton ball and pull a small bit out of it. Twist this wisp of cotton into a small wick. Dip it in some betadine (povidone-iodine solution) and use the tweezers to gently push it either under the flesh that's growing over the toenail, or under the corner of the toenail itself. This relieves the pressure as well as killing the bacteria. You'll need to repeat daily, but you'll probably find it feels better fairly soon.
posted by escapepod at 3:58 AM on October 23, 2014 [2 favorites]

Have you tried cutting it out yourself? There are a lot of bad podiatrists out there, and I've seen them make a mess of people's feet in what should be a simple surgery. (e.g. Basically cutting off the entire side of my sister's toe for a very minor ingrown nail.)

If you can handle a small amount of pain, I find it's much easier to just nip out the ingrown part myself. You need to use very sharp cuticle scissors. Not nail scissors, which are much thicker and blunter. The best ones are the ones with the cheap pink plastic handles. You go in at an angle toward the outside and bottom of the nail, so you are cutting a triangular piece out, but don't cut all the way through. Then pull that piece down, and with any luck you'll also kind of pull off a strip from the side of your toenail, which gets all of the ingrown part out. Kind of hard to describe, but I find it's very effective, and my nail never gets to the point of being very inflamed or infected.
posted by catatethebird at 4:06 AM on October 23, 2014

Get it excised properly by someone who knows what they're doing. You don't want to have to deal with a septic toe. Topical OTC antibiotics do nothing; if they were strong enough to work, they'd need a prescription.

When I had my big toe nailbed redone last year, the chiropodist was amazed at the chunk of nail he removed. He's been teaching for 20 years, and asked if he could take pictures 'cos we were amazed that it could even fit in there.

(<jest>send me $5, or I send you the pictures … They're seriously oogy.</jest>)
posted by scruss at 5:02 AM on October 23, 2014 [1 favorite]

You have gotten some horrifyingly irresponsible medical advice in this thread that is very much worth ignoring and that this community should be ashamed to host and spread.

"At this point, I expect to have to do this for the rest of my life."

There is then only one right answer to your question. Any medicine that you intend to use chronically requires the advice of a medical professional who is licensed to prescribe where you live even if it is available over the counter - which becomes particularly important when we are talking about antibiotics. Whether your toe would benefit from Neosporin when inflamed is a question for a podiatrist who can look at your toe, not the internet. A real podiatrist with your foot in front of them will be able to assess how bad it is, determine the extent of the damage to the toe, and check for non-intuitive complicating factors like neither you nor any of us can. Both the potential for generating resistance and increasing the vulnerability of your toe to the really awful bugs by eliminating health bacteria are context dependent concerns best addressed by a licensed professional who can examine your foot and provide you with expert advice.

Doing home surgery on your toe is a really great way to get the kinds of infections that lead to not having a toe anymore. Do not fuck with your nail bed with cuticle scissors, that is not a good idea.
posted by Blasdelb at 5:23 AM on October 23, 2014 [7 favorites]

You really should see a podiatrist, or even your family doctor about this. It's really easy to remove, it's really not that big of a deal, and there's a good chance you can resolve this issue permanently.

Even if you all agree that "surgery" isn't indicated (they remove the ingrown portion of the toenail, it's not like surgery surgery), they can tell you about the antibiotic thing. Personally, I wouldn't have much concern about using antibiotic ointment once a month, but I'm not a doctor.
posted by J. Wilson at 6:30 AM on October 23, 2014

Antibiotics used for topical reasons, including disinfectants such as iodine, have a low rate of selecting for resistance. The reason is that you can use a much higher concentration than you would in your blood, and completely ensure killing the bacteria. What would be toxic to a healthy human cell doesn't apply. The outer layer of skin is dead and these compounds are particularly selected for their low degree of absorption.
posted by dances_with_sneetches at 7:03 AM on October 23, 2014 [1 favorite]

I've had ingrown toenails off and on my whole life, big toes only. What I do to prevent and treat them is to file the top of my toenails flat, in a line down the center from the quick to the tip; the toenail grows towards this weak point, sometimes even forming a raised ridge down the center of the nail. As long as I do that, no problems.
posted by MrMoonPie at 8:17 AM on October 23, 2014

Surgery seems a little eager here.

Sorry if it seemed a bit of quick response. I had a bike accident that damaged my knee and foot. The big toenail was bruised and ultimately fell off. It grew back into an ingrown nail, which operated in waves of calm and pain for about 2-3 years after everything else healed.

Not being a fan of pain, I was reluctant to do the in-patient procedure, so the podiatrist clipped the nail back. He assured me, however, that it would grow back in 4-5 months — and he was right. I was right back where I started, and so it was for another year.

So I set aside a couple days where I could rest up the foot and just get it done. It was a quick job, about 30 minutes. The toe is numbed, the nail is cut back and a compound applied to the root to stop the nail growing back in the corner. I kept it clean for a couple days and then my toe was back to where I was before the accident. Problem solved.

It is among the smarter decisions I have made in my life — no more pain, no more deliberate limping to try to avoid putting pressure on my toenail.

If it is affecting your quality of life to the extent you are worried about MRSA (given your question's tags), then my advice is to look into a quick snip so you can move on with your life.
posted by a lungful of dragon at 1:19 PM on October 23, 2014 [1 favorite]