From the Guidelines
Paronychia can be effectively treated with topical povidone iodine 2% twice daily, as well as topical antibiotics and corticosteroids, with the consideration of oral antibiotics for more severe cases or those with surrounding cellulitis, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment of paronychia should be based on the severity of the condition, with mild cases managed with topical treatments and more severe cases potentially requiring oral antibiotics or surgical intervention.
- For mild acute paronychia, applying an antibiotic ointment like mupirocin or bacitracin after soaking in warm water may be sufficient.
- For more severe cases with pus collection, drainage is necessary by lifting the nail fold away from the nail plate using a sterile instrument.
- Oral antibiotics are recommended for cases with surrounding cellulitis or if the infection doesn't improve with local measures; dicloxacillin 500mg four times daily or cephalexin 500mg four times daily for 7-10 days are typical choices, as suggested by 1 and 1.
Chronic Paronychia Management
For chronic paronychia, avoiding water exposure and using cotton gloves under vinyl gloves when hands must be in water is crucial.
- Topical antifungals like ketoconazole cream or ciclopirox solution applied twice daily for several weeks may help, as chronic cases often involve fungal components.
- Severe or persistent cases may require oral antifungals like fluconazole 200mg weekly for several weeks.
Prevention
Preventive measures should also be considered, including gentle skin care instructions, preventive correction of nail curvature, avoidance of repeated friction and trauma, wearing gloves while cleaning, and avoiding biting nails or cutting nails too short, as outlined in 1 and 1. Prompt treatment is important as these infections can spread to deeper tissues if left untreated, potentially leading to more serious complications.
From the Research
Treatment Options for Paronychia
- The treatment for paronychia can be effective, but the condition is often recurrent, especially as an occupational disease 2.
- A new combination of topical medications, including an insulating polymer, two 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 2.
- Oral fluconazole can be added to the treatment for patients with proven and severe candidiasis of the nails 2.
- Clarithromycin can be used to treat patients with bacterial paronychia 2.
- The treatment evaluation at the end of the follow-up period showed a clinical cure in 46.6% of patients, improvement in 40%, and failure in 13.4% 2.
Antifungal Therapy
- Oral antifungals, such as fluconazole, itraconazole, and terbinafine, are effective in the treatment of onychomycosis and have a good safety profile 3.
- Terbinafine produces the best results when a dermatophyte is the pathogen, while the azoles, mainly itraconazole, are recommended for Candida and non-dermatophyte infections 3.
- Oral terbinafine, itraconazole, and griseofulvin, and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for the treatment of onychomycosis in the United States 4.
Treatment Considerations
- The choice of treatment for paronychia and onychomycosis should be based on the disease severity, infecting pathogen, medication safety, efficacy, and cost, as well as patient age, comorbidities, medication history, and likelihood of compliance 4.
- Physicians should consider the advantages, disadvantages, and limitations of different types of treatments, including topical and oral antifungals, and device-based therapies 5.
- A decision-making algorithm can be used to give clinicians treatment indications based on the severity stage of the condition, treatment invasiveness, and possible clinical outcomes 6.