From the Guidelines
The treatment for paronychia should be based on the severity of the condition, with Grade 0 prevention focusing on gentle skin care and Grade 1-3 treatment involving topical and oral antibiotics, corticosteroids, and potentially surgical intervention, as outlined in the ESMO clinical practice guidelines 1.
Treatment Approach
The approach to treating paronychia varies depending on the severity, which is graded according to the CTCAE v5.0. For prevention (Grade 0), measures include gentle skin care instructions, wearing comfortable shoes, avoiding nail biting or cutting nails too short, and the use of antimicrobial soaks and topical emollients 1.
Severity-Based Treatment
- For Grade 1 treatment, continuing the drug at the current dose and monitoring for changes in severity, along with topical povidone iodine 2% and topical antibiotics/corticosteroids, is recommended 1.
- Grade 2 treatment involves continuing the drug at the current dose, 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 1.
- For Grade 3 (or intolerable Grade 2) treatment, the drug should be interrupted until the condition improves to Grade 0/1, with surgical intervention or antibiotics indicated, and consideration of partial nail avulsion 1.
Key Considerations
- The pathogenesis of paronychia involves the inhibition of the EGFR and downstream pathways, leading to altered differentiation and migration of epidermal cells, which can result in secondary periungual inflammation 1.
- Secondary bacterial or mycological superinfections are present in up to 25% of cases, highlighting the need for appropriate antimicrobial therapy 1.
- The treatment should aim to reduce morbidity, mortality, and improve the quality of life, prioritizing the most recent and highest quality evidence available 1.
From the Research
Treatment Options for Paronychia
- Acute paronychia can be treated with warm soaks, topical antibiotics, and topical steroids 2, 3
- Chronic paronychia can be treated with topical steroids, calcineurin inhibitors, and avoiding exposure to irritants 2, 3
- In recalcitrant cases of chronic paronychia, surgical treatment such as en bloc excision of the proximal nail fold or eponychial marsupialization may be necessary 4, 3
- A new combination of topical medications including an insulating polymer, antifungals, and anti-inflammatory molecules has shown efficacy and tolerability in the treatment and prevention of moderate and chronic paronychia 5
Management of Paronychia
- General preventive measures are crucial in maintaining health and preventing recurrence of paronychia 4, 5
- Patient education is essential to reduce the recurrence of acute and chronic paronychia 2
- Treatment may take weeks to months, and patient compliance is necessary for effective management 2
Specific Treatment Regimens
- Topical steroid creams have been found to be more effective than systemic antifungals in the treatment of chronic paronychia 4, 3
- Oral antibiotics may be necessary in cases of severe infection or immunocompromised patients 2, 6
- Antifungal agents may be necessary in cases of candidiasis or other fungal infections 5