What is the treatment for paronychia?

Treatment of Paronychia

The most effective treatment for paronychia depends on whether it is acute or chronic, with acute cases requiring warm soaks with or without Burow solution or 1% acetic acid, and surgical drainage if an abscess is present, while chronic cases require addressing the underlying irritant and using topical steroids or calcineurin inhibitors. 1, 2

Acute Paronychia Treatment

First-Line Management

• Warm soaks with or without:
  • 50:50 vinegar dilution applied to nail folds twice daily 1
  • Burow solution or 1% acetic acid 2
• Topical antiseptics such as 2% povidone-iodine applied twice daily for inflammation without infection 1

For Persistent Inflammation

• Topical antibiotics with or without topical steroids when simple soaks don't relieve inflammation 1, 2
• Mid to high-potency topical corticosteroid ointment applied to nail folds twice daily for inflammation without infection 1

For Abscess Formation (Mandatory)

• Surgical drainage is required if an abscess is present 1, 2
• Drainage options include:
  1. Using a hypodermic needle (21G or 23G) to lift the nail fold and drain pus 1, 3
  2. Wide incision with a scalpel for more extensive abscesses 1, 2

Clinical Pearl: The DAREJD technique (lifting the nail fold with a needle tip) has been shown to provide pain relief within 2 days without requiring anesthesia or daily dressing changes 3

Oral Antibiotics

• Usually not needed if adequate drainage is achieved
• Reserved for:
  • Immunocompromised patients
  • Severe infections
  • Presence of systemic symptoms 1, 2

Chronic Paronychia Treatment

Primary Interventions

• Eliminate exposure to irritants (most important step) 1, 4
• High-potency topical corticosteroids alone or combined with topical antibiotics applied 2-3 times daily 1, 4
• Calcineurin inhibitors as a steroid-sparing alternative 1, 4

Mechanical Interventions

• Gutter splinting using a flexible tube placed on the lateral edge of the nail 1
• Taping the nail fold away from the nail plate 1

For Recalcitrant Cases

• Surgical options:
  • En bloc excision of the proximal nail fold
  • Eponychial marsupialization
  • Partial nail avulsion with phenolization (most effective for preventing recurrence) 1, 4

Prevention Strategies

• Keep hands and feet as dry as possible
• Avoid prolonged water exposure
• Apply daily topical emollients to cuticles
• Wear gloves while cleaning or doing wet work
• Proper nail trimming (straight across, not too short)
• Avoid nail biting and trauma to nail area 1

Special Considerations

• Diabetic patients require more vigilant monitoring and earlier intervention due to increased infection risk 1
• Immunocompromised patients should be treated more aggressively with lower threshold for oral antibiotics 1
• Follow-up every 2-4 weeks until resolution for chronic cases 1
• Medical evaluation is necessary for:
  • Abscess formation
  • Signs of spreading infection
  • Systemic symptoms
  • Immunocompromised status
  • Failure to improve with home treatment 1

Warning: Up to 25% of cases may result in secondary bacterial or fungal infections if not properly treated 1