From the Guidelines
Chronic paronychia of the toe is best managed by following gentle skin care instructions, including wearing comfortable shoes, wearing gloves while cleaning, and avoiding biting nails or cutting nails too short, as well as using antimicrobial soaps and applying topical emollients to cuticles and periungual tissues. According to the ESMO clinical practice guidelines 1, prevention of paronychia is crucial, and grade 0 prevention strategies should be implemented to avoid the development of the condition. For grade 1 treatment, continuing the current treatment and monitoring for changes in severity, while using topical povidone iodine 2% and topical antibiotics/corticosteroids, is recommended 1.
Key Management Strategies
- Gentle skin care instructions
- Wearing comfortable shoes and gloves while cleaning
- Avoiding nail biting or cutting nails too short
- Using antimicrobial soaps and topical emollients
- Topical povidone iodine 2% and topical antibiotics/corticosteroids for grade 1 treatment
Treatment Approach
For grade 2 treatment, continuing the current treatment and monitoring for changes in severity, while using topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, is recommended 1. In cases of grade 3 (or intolerable grade 2) treatment, interrupting treatment until the condition improves to grade 0/1, obtaining bacterial/viral/fungal cultures, and using surgical intervention or antibiotics, as well as considering partial nail avulsion, may be necessary 1.
Important Considerations
It is essential to reassess the condition after 2 weeks and adjust the treatment plan accordingly. If the reaction worsens or does not improve, dose interruption or discontinuation may be necessary 1. By prioritizing gentle skin care and proper management, the risk of chronic paronychia and its associated morbidity can be reduced, ultimately improving the patient's quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
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, 3.
- It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens 2, 3.
- 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 Options for Chronic Paronychia
- Topical steroid creams have been found to be more effective in the treatment of chronic paronychia than systemic antifungals 2, 3, 4.
- A combination of a broad-spectrum topical antifungal agent and a corticosteroid may be beneficial in treating chronic paronychia 3.
- Application of emollient lotions may also be beneficial 3.
- In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal 2, 3.
- A new combination of topical medications, including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, has shown efficacy and tolerability in the treatment and prevention of moderate and chronic paronychia 5.
Prevention and Management
- General preventive measures form the cornerstone of therapy for chronic paronychia 2.
- Patients should avoid exposure to contact irritants 3.
- Treatment of underlying inflammation and infection is recommended 3.
- Newer therapies and surgical modalities are being employed in the management of chronic paronychia 2.