From the Guidelines
The recommended treatment for paronychia is based on its severity, with Grade 0 prevention focusing on gentle skin care, Grade 1 treatment involving topical povidone iodine 2% and topical antibiotics/corticosteroids, and Grade 2 or higher treatment potentially requiring oral antibiotics, surgical intervention, or partial nail avulsion, as outlined in the ESMO clinical practice guidelines 1.
Key Considerations
- For Grade 0 prevention, gentle skin care instructions, wearing comfortable shoes, and avoiding biting nails or cutting nails too short are recommended, along with preventive correction of nail curvature and use of antimicrobial soaks and washing with cleansers and water 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% and topical antibiotics/corticosteroids, is advised 1.
- For Grade 2 treatment, obtaining bacterial/viral/fungal cultures if infection is suspected, and using topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, is recommended 1.
- In cases of Grade 3 or intolerable Grade 2 paronychia, interrupting treatment until the condition improves to Grade 0/1, obtaining cultures, and considering surgical intervention or antibiotics is necessary 1.
Additional Treatment Options
- Topical 2% povidone-iodine, daily dilute vinegar soaks to nail folds twice daily, and mid to high potency topical steroid ointment to nail folds twice daily may also be considered for symptom-directed management 1.
- Intralesional triamcinolone acetonide, recurrent or severe cases, and combination topical therapy with antibiotics and corticosteroids may be necessary for treatment-refractory cases 1.
From the Research
Treatment Options for Paronychia
- Acute paronychia treatment consists of warm soaks with or without Burow solution or 1% acetic acid, as well as topical antibiotics and steroids when simple soaks do not relieve the inflammation 2.
- In cases of chronic paronychia, treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 2.
- Topical antifungal agents and steroids may be used to treat chronic paronychia, and surgical intervention may be necessary in some cases 3.
- A new combination of topical medications, including an insulating polymer, antifungals, and a molecule with anti-inflammatory activity, has been shown to be effective in treating moderate and chronic paronychia 4.
Management of Chronic Paronychia
- General preventive measures form the cornerstone of therapy for chronic paronychia, including avoiding irritants and allergens 5.
- Topical steroid creams have been found to be more effective in the treatment of chronic paronychia than antifungals 5.
- Surgical treatment, including en bloc excision of the proximal nail fold or an eponychial marsupialization, may be necessary in recalcitrant cases 5.