From the Guidelines
Paronychia treatment should be based on the severity of the condition, with gentle skin care and preventive measures for grade 0, topical antibiotics and corticosteroids for grade 1, and oral antibiotics or surgical intervention for grade 2 or higher, as recommended by the most recent guidelines 1. The treatment approach for paronychia can be broken down into several key points:
- For prevention, gentle skin care instructions, wearing comfortable shoes, and avoiding biting nails or cutting them too short are recommended, with a level of evidence (LoE) of IV and a grade of recommendation (GoR) of B 1.
- For grade 1 treatment, continuing the drug at the current dose and monitoring for changes in severity, with topical povidone iodine 2% and topical antibiotics/corticosteroids, is suggested, with a LoE of III and a GoR of B 1.
- For grade 2 treatment, continuing the drug at the current dose and monitoring for changes in severity, with topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, is recommended, with a LoE of III and a GoR of B 1.
- For grade 3 or intolerable grade 2 treatment, interrupting the drug until the condition improves to grade 0 or 1, obtaining bacterial/viral/fungal cultures, and considering surgical intervention or antibiotics, is advised, with a LoE of III and a GoR of B 1. It's essential to note that the treatment of paronychia should prioritize preventing complications like nail deformity or spread of infection, and prompt treatment is crucial to achieve this goal. Some key aspects of paronychia treatment include:
- Keeping the area dry and clean
- Avoiding irritants and trauma
- Using topical or oral antibiotics and antifungals as needed
- Considering surgical intervention for severe cases
- Preventing future occurrences through proper nail care and protection. Overall, the treatment of paronychia should be tailored to the individual's specific condition and severity, with a focus on preventing complications and promoting healing, as supported by the most recent and highest-quality evidence 1.
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 varies depending on whether it is acute or chronic 2.
- Acute paronychia is typically caused by polymicrobial infections and can be treated with warm soaks, topical antibiotics, and topical steroids 2.
- Chronic paronychia, on the other hand, 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 reducing inflammation with topical steroids or calcineurin inhibitors 2.
Treatment Options for Acute Paronychia
- 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.
- The presence of an abscess should be determined, which mandates drainage, and there are various options for drainage, including instrumentation with a hypodermic needle or a wide incision with a scalpel 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.
Treatment Options for Chronic Paronychia
- Treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 2.
- Common irritants that should be avoided include acids, alkalis, and other chemicals used by housekeepers, dishwashers, bartenders, florists, bakers, and swimmers 2.
- More aggressive techniques may be required to restore the protective nail barrier, and treatment may take weeks to months 2.
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia 2.