Is doxycycline (antibiotic) effective in treating paronychia (infection of the nail)?

Doxycycline for Paronychia Treatment

Doxycycline is not a first-line treatment for paronychia but can be used at 100 mg twice daily for recurrent, severe, or treatment-refractory cases of paronychia, with recommended follow-up after 1 month. 1

Treatment Algorithm for Paronychia

First-Line Management

1. Non-antibiotic approaches:

   • Warm soaks with antiseptic solutions (2% povidone-iodine) 2
   • Daily dilute vinegar soaks (50:50 dilution) to nail folds twice daily 1, 2
   • Mid to high-potency topical corticosteroid ointment for inflammation 1, 2
   • Drainage if abscess is present 2, 3

2. For mild infection:

   • Topical antibiotics with steroids for inflammation 2
   • Culture if pus is present 1

Second-Line Management (When First-Line Fails)

1. For bacterial paronychia:

   • Oral antibiotics based on culture results 2
   • Empirical oral options include cephalosporins, ciprofloxacin, levofloxacin, or moxifloxacin 4

2. For fungal involvement:

   • Topical antifungals (imidazoles) 2
   • Oral fluconazole for Candida species 2
   • Itraconazole for resistant cases 2

3. For recurrent, severe, or treatment-refractory cases:

   • Doxycycline 100 mg twice daily with follow-up after 1 month 1

Evidence Analysis

The most recent and highest quality evidence from the Journal of the American Academy of Dermatology (2022) specifically mentions doxycycline at 100 mg twice daily as an option for recurrent, severe, or treatment-refractory paronychia 1. This recommendation is part of a comprehensive treatment algorithm for managing acute paronychia and periungual pyogenic granulomas.

The Praxis Medical Insights guideline (2025) provides extensive recommendations for paronychia management but does not specifically mention doxycycline 2. Instead, it emphasizes topical treatments, drainage procedures, and other oral antibiotics based on culture results.

Important Considerations

• Etiology matters: Paronychia can be caused by bacteria, fungi, viruses, or non-infectious factors 5. Doxycycline would only be effective for bacterial causes.

• Culture before antibiotics: When possible, obtain cultures before starting antibiotic therapy to guide treatment 1, 2.

• Prevention is crucial: Keeping hands dry, avoiding trauma to nails, and proper nail care are essential for preventing recurrence 2.

• Special populations: Diabetic and immunocompromised patients require more aggressive treatment and closer monitoring 2.

Potential Pitfalls

• Misdiagnosis: Antibiotic-resistant acute paronychia may be caused by non-bacterial pathogens (viruses, fungi) or non-infectious problems 5. Using doxycycline without identifying the cause may lead to treatment failure.

• Overtreatment: Many cases of paronychia can be managed with topical treatments alone 3, 6. Oral antibiotics like doxycycline should be reserved for more severe cases.

• Underlying conditions: Chronic paronychia often represents irritant dermatitis rather than infection 3. Addressing the underlying cause is essential for successful treatment.