From the Guidelines
Treatment for paronychia should be based on the severity of the condition, with mild cases (Grade 1) managed with topical povidone iodine 2%, topical antibiotics/corticosteroids, and monitoring for change in severity, as recommended by the ESMO clinical practice guidelines 1. The management of paronychia involves a step-wise approach, considering the grade of severity according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0).
- For Grade 0 prevention, gentle skin care instructions, wearing comfortable shoes, avoiding biting nails or cutting nails too short, and daily application of topical emollients to cuticles and periungual tissues 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 change in severity, with the addition of topical povidone iodine 2%, topical antibiotics/corticosteroids, is advised, with a LoE of III and a GoR of B 1.
- For more severe cases (Grade 2 or higher), treatment may involve topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, with possible surgical intervention or antibiotics indicated for Grade 3 or intolerable Grade 2 cases, as per the guidelines 1. It is essential to reassess the condition after 2 weeks and adjust the treatment plan accordingly, considering the potential for secondary bacterial or mycological superinfections, which are present in up to 25% of cases 1.
From the Research
Treatment Options for Paronychia
The treatment for paronychia depends on whether it is acute or chronic.
- For acute paronychia, treatment options include:
- Warm compresses
- Topical antibiotics, with or without corticosteroids
- Oral antibiotics
- Surgical incision and drainage for more severe cases 2
- For chronic paronychia, treatment involves:
- Avoiding exposure to contact irritants
- Using a combination of a broad-spectrum topical antifungal agent and a corticosteroid
- Applying emollient lotions
- Topical steroid creams, which are more effective than systemic antifungals 2
Surgical Treatment
In recalcitrant chronic paronychia, surgical options are available, including:
- En bloc excision of the proximal nail fold
- Eponychial marsupialization, with or without nail removal 2
Management of Infections
For purulent infections of the periungual area, the procedure involves:
- Careful removal of the focal infection in the area of the nail fold
- Opening of the abscess
- Excision of the eponychium
- Mobilization of the nail barrier away from the nail plate
- Inzision of the nail barrier at a defined place
- Necrosectomy
- Irrigation and drainage
- Moist dressings and fingerbaths in the first few days 3