From the Guidelines
Chronic paronychia should be managed with a combination of gentle hand care, topical steroids, and preventive measures to address both the inflammatory component and underlying causes, as recommended by the most recent guidelines 1.
Key Components of Management
- Gentle hand care: keep hands dry, avoid irritants, and minimize water exposure by wearing cotton-lined waterproof gloves for wet work
- Topical steroids: apply a topical steroid such as betamethasone 0.1% cream to the affected area twice daily for 2-3 weeks to reduce inflammation
- Preventive measures:
- Avoid repeated friction and trauma/excessive pressure
- Wear gloves while cleaning
- Avoid biting nails or cutting nails too short
- Use antimicrobial soaps and wash with cleansers and water
- Regularly trim nails to ensure they are straight and not too short
- Apply topical emollients to cuticles and periungual tissues daily
Additional Treatment Options
For cases with suspected fungal infection, add an antifungal like clotrimazole 1% cream, applying it after the steroid 1. Bacterial superinfection may require oral antibiotics such as dicloxacillin 500mg four times daily for 7-10 days. For severe or resistant cases, oral antifungals like itraconazole 200mg daily for 6-12 weeks might be necessary. Topical povidone iodine 2% b.i.d. has also shown benefit in a controlled study 1.
Importance of Early Intervention
Chronic paronychia develops due to repeated minor trauma disrupting the protective cuticle barrier, allowing irritants and microorganisms to enter the nail fold, as noted in earlier studies 1. The condition creates a cycle of inflammation that can persist for months or years if not properly managed. Improvement typically takes several weeks of consistent treatment, and patients should understand that complete resolution may require 3-6 months of adherence to both medication and preventive measures.
From the Research
Definition and Causes of Chronic Paronychia
- Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger, presenting as redness, tenderness, and swelling 2.
- It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens, commonly seen in housewives and housemaids 2.
- Repeated bouts of inflammation lead to fibrosis of the proximal nail fold with poor generation of cuticle, exposing the nail further to irritants and allergens 2.
Treatment and Prevention of Chronic Paronychia
- General preventive measures form the cornerstone of therapy, with topical steroid creams found to be more effective than anti-fungals in treatment 2.
- A new combination of topical medications, including an insulating polymer, antifungals, and a molecule with anti-inflammatory activity, has been shown to be effective in treating and preventing moderate and chronic paronychia 3.
- Treatment may also involve stopping the source of irritation and using topical steroids or calcineurin inhibitors to reduce inflammation 4.
- A strict irritant-avoidance regimen, combined with a broad-spectrum topical antifungal agent such as ciclopirox 0.77%, has been recommended for managing simple chronic paronychia and onycholysis 5.
Management and Recurrence Prevention
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia 4.
- Methods to prevent recurrences, such as avoiding contact irritants and using topical treatments, are essential in managing chronic paronychia 3, 4, 5.
- Emerging therapies and devices, such as those used to treat onychomycosis, may also be considered in the management of chronic paronychia 6.