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BACKGROUND Treatment of ingrown toenail includes various nonsurgical and surgical treatments. However, there is no consensus on the ideal first-choice treatment. OBJECTIVE To compare phenolization versus surgical matricectomy (SM) after lateral nail plate avulsion in terms of efficacy, recurrence rates, postoperative outcomes, and cosmesis. METHODS The authors enrolled 45 consenting patients and randomized them into 2 groups (Group 1 5 phenolization and Group 2 5 SM) using stratified block randomization and followed them up at 1 week, 1 month, and 6 months. RESULTS The median percentage improvement in pain visual analog scale (VAS) score was comparable between the 2 groups (p 5 0.793). The mean photo VAS showed significant improvement in Group 1 at 1 week (p 5 0.00) and 1 month (p 5 0.02) but not at 6 months (p 5 0.44). The median number of days for pain relief (p 5 0.169), for healing (p 5 0.192), and for resuming work (p 5 0.136) were not significantly different between the 2 groups. The time required to regain normal morphology was significantly longer in Group 2 (p 5 0.006). None of the patients in either group presented with recurrence at 6 months and 1 year. The authors observed failure of treatment in 1 patient in Group 2. CONCLUSION Both procedures were equally efficacious, had minimal complications, and showed no recurrence at 6 months and 1 year. MethodologyThis study was a hospital-based, parallel-group RCT done on patients with IGN attending the Dermatology Out-Patient Department of Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, from July 2016 to April 2018, after obtaining ethical clearance from the Institute Ethics Committee. At the end of the clinical assessment, the authors graded the disease severity using the Heifetz classification. 2,4 The authors registered the trial at Clinical Trials Registry-India, with registration number CTRI/2017/09/009951. Inclusion CriteriaThe authors included all patients with IGN above 18 years of age with symptomatic recurrence after conservative management at all stages of the disease as per Heifetz classification. 2,4 c Stage I disease includes erythema and swelling of nail grooves.