From the Research
Oral antibiotics are usually not needed for paronychia if adequate drainage is achieved, unless the patient is immunocompromised or a severe infection is present. The treatment of paronychia typically involves warm soaks with or without Burow solution or 1% acetic acid, and topical antibiotics should be used with or without topical steroids when simple soaks do not relieve the inflammation 1.
Key Considerations
- The presence of an abscess should be determined, which mandates drainage, and there are a variety of options for drainage, ranging from instrumentation with a hypodermic needle to a wide incision with a scalpel.
- Therapy is based on the most likely pathogens and local resistance patterns.
- Chronic paronychia is characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier, and treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors.
Treatment Approach
- For patients who require oral antibiotics, the choice of antibiotic should be based on the most likely pathogens and local resistance patterns.
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia.
- Treatment may take weeks to months, and patients should be monitored for clinical improvement, with resolution of erythema, swelling, and pain.
Important Notes
- The use of oral antibiotics should be reserved for severe cases or cases where the patient is immunocompromised, and the treatment should be tailored to the individual patient's needs and response to treatment 1.