From the Guidelines
For paronychia treatment, the most effective approach is to start with warm water soaks and apply topical treatments as needed, with the most recent and highest quality study recommending topical povidone-iodine 2% and topical antibiotics/corticosteroids for grade 1 treatment, and oral antibiotics for more severe cases 1.
Key Considerations
- Paronychia is an infection of the skin around the nail, often caused by bacteria entering through small cuts.
- Prompt treatment is important to prevent the infection from spreading to deeper tissues or the bloodstream.
- The most recent study from 2021 provides a comprehensive guide for the treatment of paronychia, including topical and oral treatments, as well as preventive measures 1.
Treatment Options
- For mild cases, warm water soaks 3-4 times daily for 15 minutes each, and application of topical antibiotic ointments like bacitracin or neomycin after each soak.
- For grade 1 treatment, topical povidone-iodine 2% and topical antibiotics/corticosteroids are recommended 1.
- For more severe cases, oral antibiotics such as dicloxacillin or cephalexin, typically 500 mg four times daily for 7-10 days, may be prescribed.
- In cases involving pus, drainage may be necessary.
Preventive Measures
- Keep nails trimmed to prevent nail biting and cuticle cutting.
- Wear protective gloves when hands are frequently exposed to water.
- Avoid repeated friction and trauma/excessive pressure on the nail area.
- Use antimicrobial soaks and washing with cleansers and water to keep the area clean.
- Apply topical emollients to cuticles and periungual tissues daily to prevent dryness and irritation 1.
From the Research
Treatment Options for Paronychia
The treatment for paronychia, an infection of the nail bed, can vary depending on the severity and cause of the condition.
- Topical steroid creams have been found to be effective in the treatment of chronic paronychia 2.
- In recalcitrant cases, surgical treatment may be necessary, which can include en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal 2.
- For paronychia induced by targeted anticancer therapies, surgical intervention such as partial matricectomy, nail avulsion, debridement/clipping, and incision and drainage may be beneficial 3.
- Partial matricectomy has been shown to be an effective treatment for targeted therapy-related paronychia, providing a shorter course of treatment, reduced pain, and improved appearance of the healed wound 4.
Surgical Intervention
Surgical intervention may be necessary for severe or recalcitrant cases of paronychia.
- A retrospective case series found that partial matricectomy had a resolution rate of 100% (11/11) for paronychia induced by targeted anticancer therapies 3.
- Another study found that surgical partial matricectomy was an effective and enduring intervention for targeted therapy-related paronychia, resulting in a better quality of life during targeted therapy than conservative treatments 4.
Conservative Treatment
Conservative treatment options for paronychia include antibiotics and steroids.
- However, these treatments may be inadequate for severe paronychia, and surgical intervention may be necessary 3.
- A study found that fluconazole, an antifungal medication, was effective in the treatment of distal subungual onychomycosis of the toenail, with clinical success rates of 86-89% at the end of therapy 5.