From the Guidelines
Paronychia can be effectively treated based on its severity, with mild cases managed at home and more severe cases requiring medical attention, as outlined in the most recent guidelines from 2021 1. To treat paronychia, it's essential to understand its severity, which can be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
- For Grade 0 prevention, gentle skin care instructions, wearing comfortable shoes, and avoiding biting nails or cutting them too short are recommended, along with the use of antimicrobial soaps and daily application of topical emollients to cuticles and periungual tissues 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, are suggested 1.
- For Grade 2 treatment, continuing the drug at the current dose, obtaining bacterial/viral/fungal cultures if infection is suspected, and using topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics are recommended 1.
- For Grade 3 (or intolerable Grade 2) treatment, interrupting the drug until the condition improves to Grade 0/1, obtaining cultures, and considering surgical intervention or antibiotics, including partial nail avulsion, may be necessary 1. It's crucial to note that paronychia can progress into the formation of friable granulation tissue on the lateral folds of the nail, mimicking ingrown nails, and secondary bacterial or mycological superinfections are present in up to 25% of cases 1. The pathogenesis of paronychia is thought to result from the inhibition of the EGFR and downstream EGFR-dependent pathways in basal and suprabasal keratinocytes, leading to altered differentiation and migration of epidermal cells 1. In terms of specific treatments, topical povidone iodine 2% and topical antibiotics/corticosteroids are recommended for Grade 1 treatment, while oral antibiotics like cephalexin or clindamycin may be required for more severe cases 1. Overall, the treatment of paronychia should be guided by the severity of the condition and the presence of any superinfections, with a focus on preventing further complications and promoting healing.
From the FDA Drug Label
Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage To treat paronychia, clean the affected area and apply a small amount of bacitracin (TOP) 1 to 3 times daily, which may be covered with a sterile bandage 2.