From the Guidelines
Paronychia is classified into four grades based on severity, with Grade 0 being prevention, Grade 1 being mild, Grade 2 being moderate, and Grade 3 being severe, as defined by the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 1. The grades of paronychia are defined as follows:
- Grade 0: prevention, which involves gentle skin care instructions, preventive correction of nail curvature, avoidance of repeated friction and trauma, and daily application of topical emollients to cuticles and periungual tissues 1.
- Grade 1: mild paronychia, which presents with nail fold oedema or erythema, and is treated with topical povidone iodine 2%, topical antibiotics, and corticosteroids 1.
- Grade 2: moderate paronychia, which involves nail fold oedema or erythema with pain, and is treated with topical povidone iodine 2%, topical beta-blocking agents, topical antibiotics, and corticosteroids, and/or oral antibiotics 1.
- Grade 3: severe paronychia, which extends beyond the nail fold, affecting deeper tissues or spreading to adjacent fingers, and may involve systemic symptoms like fever, and is treated with interruption of the offending drug, surgical intervention, or antibiotics 1. The treatment of paronychia varies by grade, with higher grades requiring more aggressive interventions to prevent complications like permanent nail deformity or spread of infection to deeper structures. Some key points to consider in the management of paronychia include:
- Gentle skin care and preventive measures to avoid repeated friction and trauma 1
- Topical antibiotics and corticosteroids for mild to moderate paronychia 1
- Oral antibiotics and/or surgical intervention for severe paronychia 1
- Regular monitoring and follow-up to assess the response to treatment and adjust the management plan as needed 1
From the Research
Classification of Paronychia
Paronychia can be classified into different types, including:
- Acute paronychia: caused by polymicrobial infections after the protective nail barrier has been breached 2, 3, 4, 5
- Chronic paronychia: characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier 2, 3, 6, 4, 5
- Congenital paronychia: a rare condition, not commonly discussed in the provided studies
- Acute-acquired paronychia: usually caused by trauma 6
- Chronic-acquired paronychia: associated with numerous occupations where fluids are the common denominator 6
Grades of Paronychia
While the provided studies do not explicitly mention different "grades" of paronychia, they do discuss the severity of the condition and the corresponding treatment options. For example:
- Mild cases of acute paronychia may be treated with warm soaks and topical antibiotics 2, 3
- More severe cases of acute paronychia may require surgical drainage of an abscess 2, 3, 4
- Chronic paronychia may require treatment with topical steroids or calcineurin inhibitors, and more aggressive techniques may be required to restore the protective nail barrier 2, 3, 6, 4, 5