Ingrown Toenail Content on TikTok: A Cross-Sectional Analysis

Ingrown toenail, or onychocryptosis, occurs when the nail plate penetrates the periungual dermis, often causing inflammation and/or infection. [1] It is a common condition, causing pain and impacting quality of life. With 1.58 billion monthly active users, TikTok has become a significant platform for health-related content. [2] This study aimed to assess ingrown toenail related content on TikTok and its implications.

Methods

We queried TikTok for the 100 most-viewed videos under search terms “ingrown toenail” and “ingrown toenail removal” from January 18, 2024 to July 18, 2024. Data werecollected on engagement metrics (likes, views, comments, saves, and shares), tools used, and glove use. Severity was classified into stages (I=mild, II=moderate, III=severe) based on presence of swelling, acute infection, and chronic inflammation, respectively. [1] Infection score (0–3) was determined by presence of erythema (1), swelling (1), and/or pus (1). All unrelated content was excluded prior to analysis.

Results

The 100 most-viewed ingrown toenail videos generated 235 million views, with an average of 2.36 million views, 382,000 likes, 276 comments, 1,969 saves, and 1,812 shares.

Most videos (98%) described “rounding off” the nail plate corners with a blade (87%), followed by use of a cuticle trimmer (34%), probe (9%), or forceps (8%). Other instruments used included tweezers (4%), other (3%), Q-tip (2%), and a nail drill (2%). Gloves were used in 87% of videos. Clinical presentation across videos varied in severity: stage I (n = 73), II (n = 20), III (n = 7). Infection score was not associated with any tool type (P > 0.05). No videos had spoken audio. No videos were uploaded by podiatrists or physicians.

Discussion

Ingrown toenail content on TikTok generated high view counts and predominantly involved lateral nail edge excision with a blade or cuticle trimmer. This approach is not consistent with nail care tips recommended by the American Academy of Dermatology on their public education website, which describes cutting nails straight across, or conservative and surgical ingrown toenail treatment options. [1,3] Rounding off the lateral nail corner is a significant risk factor for ingrown toenails, as it may create barbs and spicules that perpetuate a cycle of poor healing. [1] We reported stage II or III ingrown toenails in 27% of videos. In such instances, timely treatment may prevent secondary infection and associated complications, especially in diabetic patients. [4]

The TikTok platform can be used to disseminate evidence-based nail education and advise patients to consult a podiatrist or dermatologist, particularly for infections. [3] However, in its current state, ingrown toenail content on TikTok promotes harmful practices. Thus, future efforts include increased podiatrist/dermatologist presence in viral videos to promote nail education and cautionary advisories on related content to moderate misleading information.

Limitations

Since TikTok’s algorithm for selecting top videos by hashtag is constantly changing, similar analysis may yield variable results at different times. Classification of ingrown toenails was determined by clinical presentation on video alone, which may be subjective as it lacks clinical context necessary for comprehensive medical evaluation.

Conclusions

On TikTok, ingrown nail content largely involves unconventional management techniques that are not consistent with proper nail care recommendations. The lack of quality ingrown toenail videos highlights the risk of misinformation, which may be addressed with greater presence of verified educational content and improved content moderation.