From the Guidelines
Paronychia drainage is a crucial intervention for managing paronychia, as emphasized by the most recent and highest quality study 1, which highlights the importance of drainage in the treatment of paronychia. To drain a paronychia, the following steps should be taken:
- Clean the area with antiseptic solution like chlorhexidine or povidone-iodine
- Use a digital nerve block with 1-2% lidocaine without epinephrine for pain control
- Make a small incision with a #11 scalpel blade or sterile needle at the point of maximal fluctuance, parallel to the nail edge
- Gently express all purulent material and irrigate with sterile saline After drainage, apply a non-adherent dressing and elevate the affected digit. The study 1 also recommends topical povidone iodine 2%, topical antibiotics/corticosteroids, and oral antibiotics for the treatment of paronychia, depending on the severity of the condition. It is essential 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, as mentioned in the study 1. Therefore, drainage, along with appropriate antibiotic treatment and wound care, is essential for effective management of paronychia and prevention of complications, as supported by the study 1.
From the Research
Paronychia Drainage
- Paronychia is inflammation of the fingers or toes in one or more of the three nail folds, and drainage is a crucial step in treating acute paronychia, especially when an abscess is present 2, 3, 4.
- The presence of an abscess in acute paronychia mandates drainage, which can be achieved through various methods, including instrumentation with a hypodermic needle or a wide incision with a scalpel 2.
- Treatment options for acute paronychia include warm compresses, topical antibiotics, with or without corticosteroids, oral antibiotics, or surgical incision and drainage for more severe cases 3.
- In cases of chronic paronychia, treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors, and more aggressive techniques may be required to restore the protective nail barrier 2, 3.
- The procedure for paronychia drainage is selected based on the stage of infection, with careful removal of the focal infection in the area of the nail fold, and may involve opening of the abscess, excision of the eponychium, mobilization of the nail barrier away from the nail plate, and irrigation and drainage 4.
Methods of Drainage
- Instrumentation with a hypodermic needle 2
- Wide incision with a scalpel 2
- Opening of the abscess 4
- Excision of the eponychium 4
- Mobilization of the nail barrier away from the nail plate 4
- Inzision of the nail barrier at a defined place 4
- Necrosectomy 4
- Irrigation and drainage 4