From the Guidelines
Paronychia treatment should be guided by the severity of the condition, with mild cases managed with gentle skin care, topical antibiotics, and monitoring, while more severe cases may require oral antibiotics, surgical intervention, or interruption of any offending medications, as recommended by the most recent guidelines 1.
Treatment Approach
The approach to treating paronychia depends on the severity of the condition, which can be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. For Grade 0 prevention, gentle skin care instructions, including wearing comfortable shoes, gloves while cleaning, and avoiding nail biting or cutting nails too short, are recommended, along with the use of antimicrobial soaks and topical emollients 1.
Mild Paronychia (Grade 1)
For Grade 1 treatment, continuing the drug at the current dose and monitoring for changes in severity, along with topical povidone iodine 2% and topical antibiotics/corticosteroids, is advised 1. Reassessment after 2 weeks is crucial to determine if the reaction has worsened or improved.
Moderate to Severe Paronychia (Grade 2 and above)
For Grade 2 and above, treatment involves continuing the drug at the current dose and monitoring, with the addition of topical povidone iodine 2%, topical beta-blocking agents, topical antibiotics, and corticosteroids, or oral antibiotics 1. In cases of suspected infection, obtaining bacterial/viral/fungal cultures is necessary. For Grade 3 or intolerable Grade 2 paronychia, interrupting the offending medication until the condition improves to Grade 0 or 1, and considering surgical intervention or antibiotics, is recommended 1.
Key Considerations
- Prevention is crucial and involves gentle skin care, avoiding trauma, and keeping the area clean and dry.
- Drainage of pus by a healthcare provider may be necessary in cases where an abscess has formed.
- Topical and oral antibiotics may be prescribed based on the severity and suspected cause of the paronychia.
- Addressing underlying causes, such as frequent water exposure or nail biting, is essential for managing chronic paronychia.
- Regular reassessment to adjust treatment as necessary is vital for effective management.
Given the potential for paronychia to be caused by or complicated by bacterial or fungal infections, and considering the guidelines provided, the most appropriate and recent evidence-based approach to treating paronychia is outlined in the Annals of Oncology guidelines 1, which prioritize a stepped approach based on severity and response to initial treatment.
From the Research
Paronychia Treatment Overview
- Paronychia is inflammation of the fingers or toes in one or more of the three nail folds, and its treatment depends on whether it is acute or chronic 2.
- Acute paronychia is caused by polymicrobial infections and can be treated with warm soaks, topical antibiotics, and topical steroids 2.
- Chronic paronychia is characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier, requiring treatment aimed at stopping the source of irritation and using topical steroids or calcineurin inhibitors 2.
Treatment Options
- Warm soaks with or without Burow solution or 1% acetic acid can be used to treat acute paronychia 2.
- Topical antibiotics should be used with or without topical steroids when simple soaks do not relieve the inflammation 2.
- Oral antibiotics are usually not needed if adequate drainage is achieved unless the patient is immunocompromised or a severe infection is present 2, 3.
- Incision and drainage (I&D) remains the standard of care for skin abscesses, including paronychia, and wound packing and post-procedural antibiotics may not be necessary in uncomplicated cases 4.
Specific Considerations
- The presence of an abscess should be determined, which mandates drainage, and there are various options for drainage, ranging from instrumentation with a hypodermic needle to a wide incision with a scalpel 2, 5.
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia 2.
- Onychomycosis, a fungal infection of the nail, can be associated with paronychia and may require antifungal treatment 6.