From the Guidelines
The most effective treatment for paronychia of the great toe is drainage, especially when pus is present, as emphasized in the most recent and highest quality study 1.
Key Considerations
- The treatment approach should prioritize preventing the infection from spreading deeper into the tissue or affecting the nail bed.
- For mild cases, warm water soaks and topical antibiotics may be sufficient.
- In cases of significant swelling, redness, and pain, oral antibiotics such as dicloxacillin or cephalexin may be necessary for 7-10 days.
- Chronic paronychia may require antifungal treatments like clotrimazole or ketoconazole cream.
- Keeping the affected area clean and dry, avoiding tight footwear, and refraining from manipulating or biting the nail are crucial preventive measures.
Treatment Details
- Drainage is essential for paronychia with pus and should be performed under sterile conditions with local anesthesia 1.
- Topical treatments such as povidone iodine 2%, topical antibiotics, and corticosteroids can be used for grade 1 and 2 paronychia, as per the guidelines 1.
- For more severe cases (grade 3 or intolerable grade 2), interruption of the causative agent, surgical intervention, or antibiotics may be indicated, along with reassessment after 2 weeks 1.
Preventive Measures
- Gentle skin care, wearing comfortable shoes, avoiding nail biting, and using antimicrobial soaps are recommended preventive measures 1.
- Daily application of topical emollients to the cuticles and periungual tissues can help prevent paronychia 1.
Pathogenesis and Severity
- Paronychia's pathogenesis involves altered differentiation and migration of epidermal cells, leading to periungual inflammation 1.
- The severity of paronychia can be graded according to the CTCAE v5.0 or a novel scoring system considering redness, oedema, discharge, and granulation tissue 1.
From the Research
Treatment Options for Paronychia of the Great Toe
The recommended treatment for paronychia of the great toe involves a combination of methods to manage the infection and promote healing.
- Warm soaks with or without Burow solution or 1% acetic acid can be used to relieve inflammation, as suggested by 2.
- Topical antibiotics, with or without topical steroids, may be used when simple soaks do not provide relief, according to 2.
- In cases where an abscess is present, drainage is necessary, and there are various options for this, including instrumentation with a hypodermic needle or a wide incision with a scalpel, as mentioned in 2.
- Oral antibiotics are typically not required unless the patient is immunocompromised or has a severe infection, as stated in 2.
Management of Chronic Paronychia
For chronic paronychia, which is characterized by symptoms lasting at least six weeks, treatment focuses on:
- Identifying and stopping the source of irritation, as noted in 2.
- Using topical steroids or calcineurin inhibitors to treat inflammation, as suggested by 2.
- Implementing more aggressive techniques if necessary to restore the protective nail barrier, according to 2.
Surgical Intervention
In some cases, surgical intervention may be necessary, involving:
- Careful removal of the focal infection in the nail fold area, as described in 3.
- Procedures such as opening of the abscess, excision of the eponychium, mobilization of the nail barrier, and necrosectomy, as outlined in 3.
- Follow-up care including moist dressings and fingerbaths to promote healing, as mentioned in 3.