From the Research
Mild cases of paronychia can be treated with antibiotics alone, but moderate to severe cases typically require both antibiotics and incision and drainage (I&D). The decision to use antibiotics alone or in combination with I&D depends on the severity of the infection and the presence of an abscess. According to the most recent and highest quality study 1, surgical excision of paronychia without antibiotic coverage can give excellent results with only rare recurrence, emphasizing the importance of proper surgical intervention.
For early or mild paronychia without abscess formation, oral antibiotics such as dicloxacillin 500 mg four times daily, cephalexin 500 mg four times daily, or clindamycin 300 mg four times daily for 7-10 days may be sufficient 2. Topical antibiotics like mupirocin or bacitracin can also be used for very mild cases. However, if there is significant pus collection, fluctuance, or severe pain and swelling, I&D becomes necessary as antibiotics alone cannot adequately penetrate the abscess.
Warm water soaks for 15 minutes, 3-4 times daily, can help regardless of severity 3. The reason I&D is often needed is that antibiotics have limited penetration into abscess cavities, and the physical removal of pus reduces bacterial load and pressure, providing immediate pain relief and allowing better antibiotic effectiveness. Delaying necessary I&D can lead to deeper infection, potential osteomyelitis, or permanent nail deformity, so prompt evaluation by a healthcare provider is important if symptoms worsen despite antibiotic therapy.
Key considerations in the treatment of paronychia include:
- The presence of an abscess, which mandates drainage 2
- The severity of the infection, which determines the need for antibiotics and/or I&D
- The patient's overall health status, including any immunocompromised conditions that may affect treatment outcomes 1
- The importance of patient education to reduce the recurrence of acute and chronic paronychia 2