What is the treatment for paronychia?

Treatment of Paronychia

The treatment of paronychia should follow a graded approach based on severity, with topical therapies including antiseptics and antibiotics as first-line treatment for mild cases, progressing to oral antibiotics for moderate cases, and surgical drainage for severe cases with abscess formation. 1

Understanding Paronychia

Paronychia is an inflammation of the nail folds surrounding the nail plate, characterized by:

• Erythema, swelling, and tenderness of the nail folds
• Potential discharge or pus formation
• Possible nail plate separation in advanced cases
• Can be acute (sudden onset) or chronic (lasting >6 weeks)

Treatment Algorithm Based on Severity

Grade 1 (Mild) Paronychia

• First-line treatments:
  • Warm water soaks for 15 minutes 3-4 times daily 1
  • White vinegar soaks (1:1 dilution) for 15 minutes daily 1
  • Topical 2% povidone-iodine applied twice daily 1
  • Mid to high potency topical corticosteroid ointment to nail folds twice daily 1
  • Topical antibiotics if signs of superficial infection 1

Grade 2 (Moderate) Paronychia

• Continue topical treatments as above
• Add oral antibiotics if spreading infection or no improvement with topical therapy 1
• Obtain bacterial/viral/fungal cultures if infection is suspected 1
• Consider taping nail fold away from nail plate for onychocryptosis (ingrown nail) 1
• Silver nitrate application weekly if over-granulation tissue has developed 1

Grade 3 (Severe) Paronychia with Abscess

• Surgical drainage is indicated 1
• Options include:
  • Needle aspiration for small, superficial abscesses
  • Incision and drainage for larger collections
  • Partial nail avulsion may be necessary for severe cases 1
• Continue oral antibiotics based on culture results 1
• Consider specialist referral (dermatology, podiatry) 1

Special Considerations

Chronic Paronychia

• Identify and eliminate irritant exposure (water, chemicals, trauma) 2
• Topical steroids or calcineurin inhibitors for underlying dermatitis 2
• Consider antifungal therapy if fungal infection is suspected 3
• More aggressive nail barrier restoration techniques may be needed 2

Prevention Strategies

• Keep hands and feet dry; avoid prolonged exposure to moisture 1
• Proper nail cutting technique (straight across, not too short) 1
• Avoid nail trauma and irritants 1
• Wear protective gloves for wet work or exposure to chemicals 1
• Regular application of emollients to cuticles and periungual tissues 1
• Comfortable, well-fitting shoes for toenail paronychia prevention 1

Common Pitfalls to Avoid

1. Delayed drainage of abscesses - can lead to spreading infection and tissue damage
2. Overuse of topical steroids - should be discontinued if bacterial infection is present
3. Failure to obtain cultures in moderate to severe cases or when treatment is failing
4. Missing underlying causes in chronic paronychia (irritant exposure, systemic conditions)
5. Inappropriate nail cutting that predisposes to ingrown nails and subsequent paronychia

Early intervention with appropriate treatment based on severity is crucial for preventing complications and improving outcomes in patients with paronychia.