From the Guidelines
Treatment for paronychia should be based on the severity of the condition, with mild cases managed with gentle skin care and topical treatments, and more severe cases requiring oral antibiotics or surgical intervention. According to the most recent guidelines 1, the treatment for paronychia depends on the grade of severity, with Grade 0 prevention focusing on gentle skin care instructions, wearing comfortable shoes, and avoiding biting nails or cutting nails too short. For Grade 1 treatment, topical povidone iodine 2% and topical antibiotics/corticosteroids are recommended, while Grade 2 treatment involves topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics.
Key Considerations
- For Grade 1 paronychia, topical povidone iodine 2% and topical antibiotics/corticosteroids are recommended 1.
- For Grade 2 paronychia, topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics are recommended 1.
- For Grade 3 or intolerable Grade 2 paronychia, interrupting treatment until the condition improves to Grade 0/1, obtaining bacterial/viral/fungal cultures, and considering surgical intervention or antibiotics is necessary 1.
Additional Recommendations
- Gentle skin care instructions, including wearing comfortable shoes and avoiding biting nails or cutting nails too short, can help prevent paronychia 1.
- Topical emollients can be applied daily to cuticles and periungual tissues to improve nail strength 1.
- Biotin can be used to improve nail strength 1.
- Antimicrobial soaks and washing with cleansers and water can help prevent paronychia 1.
From the Research
Treatment Options for Paronychia
- The treatment for paronychia consists of warm soaks with or without Burow solution or 1% acetic acid, as well as topical antibiotics and topical steroids when simple soaks do not relieve the inflammation 2.
- In cases where an abscess is present, drainage is necessary, and there are various options for drainage, including instrumentation with a hypodermic needle or a wide incision with a scalpel 2, 3.
- Oral antibiotics are usually not needed if adequate drainage is achieved, unless the patient is immunocompromised or a severe infection is present 2.
- For chronic paronychia, treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 2.
- In some cases, more aggressive techniques may be required to restore the protective nail barrier, and treatment may take weeks to months 2.
Drainage Techniques
- A simple technique for draining acute paronychia involves lifting the nail fold with the tip of a needle, using materials such as a 23G or 21G needle, cotton wool, chlorohexidine solution, methylated spirit, and zinc oxide plaster 3.
- This technique has been shown to be effective in relieving pain and allowing patients to use their fingers normally within 2 days, without the need for anesthesia or daily dressing 3.
- An intra-sulcal approach is preferable to a nail fold incision for surgical drainage of an abscess in paronychia not associated with an ingrowing toenail 4.
Additional Considerations
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia 2.
- Chronic paronychia that is unresponsive to standard treatment should be investigated for unusual causes, such as malignancy, and a dermatology consultation should be obtained for suspected chronic paronychia 4.
- Large, prospective studies are needed to identify the best treatment regimen for acute and chronic paronychia 5.