How do you manage paronychia?

From the Guidelines

Management of paronychia should prioritize preventive measures, including gentle skin care, avoidance of repeated friction and trauma, and daily application of topical emollients to cuticles and periungual tissues, as recommended by the most recent guidelines 1. The approach to managing paronychia involves a combination of preventive and therapeutic strategies. Preventive management includes:

• Gentle skin care instructions
• Preventive correction of nail curvature with referral to a podiatrist if needed
• Avoidance of repeated friction and trauma/excessive pressure
• Wearing gloves while cleaning
• Avoiding biting nails or cutting nails too short
• The use of antimicrobial soaks and washing with cleansers and water
• Regular trimming of the nails ensuring that they are straight and not too short
• Daily application of topical emollients to cuticles and periungual tissues
• Wearing comfortable well-fitting shoes and cotton socks

Therapeutic management of paronychia may involve conservative measures such as high-potency topical corticosteroids alone or combined with topical antibiotics, silver nitrate chemical cauterisation, and taping with stretchable tapes. For grade 1 and 2 paronychia, topical povidone iodine 2% b.i.d. has shown benefit in a controlled study 1. In cases of intolerable grade 2 or grade 3 paronychia/pyogenic granuloma, surgical treatment with partial nail plate avulsion may be necessary. It is essential to closely monitor patients for early symptoms suggestive of pyogenic granuloma and to consider cryotherapy as a treatment option for pyogenic granuloma. The most recent and highest quality study on this topic is from 2021, published in the Annals of Oncology 1, which provides a comprehensive guide to the prevention and management of paronychia.

From the Research

Management of Paronychia

To manage paronychia, the following steps can be taken:

• For acute paronychia, treatment consists of warm soaks with or without Burow solution or 1% acetic acid 2.
• Topical antibiotics should be used with or without topical steroids when simple soaks do not relieve the inflammation 2.
• The presence of an abscess should be determined, which mandates drainage 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.
• A new combination of topical medications, including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, has been shown to be effective in the treatment and prevention of moderate and chronic paronychia 4.

Drainage Techniques

Different drainage techniques can be used to manage paronychia, including:

• Instrumentation with a hypodermic needle 3.
• A wide incision with a scalpel 2.
• Lifting the nail fold with the tip of a needle to drain the abscess 3.

Prevention

Prevention of paronychia is also important, especially in cases of occupational hand disease 4.

• General preventive measures can be useful in maintaining health and reducing the recurrence of paronychia 2, 4.
• Patient education is paramount to reduce the recurrence of acute and chronic paronychia 2.