What is the prescription for paronychia?

Treatment of Paronychia

For paronychia treatment, the recommended approach includes warm soaks with antiseptic solutions, topical antibiotics with steroids for inflammation, and surgical drainage if an abscess is present. 1

Classification and Initial Management

Acute Paronychia

• First-line treatment:

  • Warm soaks with antiseptic solutions (2-3 times daily)
  • Daily dilute vinegar soaks (50:50 dilution) to nail folds twice daily 1
  • Mid to high-potency topical corticosteroid ointment for inflammation 1
  • Topical antibiotics with steroids when simple soaks don't relieve inflammation 2

• For abscess formation:

  • Surgical drainage is mandatory 1, 2
  • Drainage options range from using a hypodermic needle to a wide incision with a scalpel 2
  • Obtain culture before starting antibiotic therapy to guide treatment 1

• Oral antibiotics:

  • Usually not needed if adequate drainage is achieved 2
  • Indicated for immunocompromised patients or severe infections 2
  • Selection based on most likely pathogens and local resistance patterns 2

Chronic Paronychia (symptoms lasting ≥6 weeks)

• Primary treatment:
  • High-potency topical corticosteroids alone or combined with topical antibiotics 1
  • For fungal involvement: Topical antifungals (imidazoles) 1
  • For Candida species: Oral fluconazole 1
  • For resistant fungal cases: Itraconazole (more effective than terbinafine) 1

Special Populations

Diabetic Patients

• Require more vigilant monitoring and earlier intervention 1
• Keep the area dry to prevent further infection 1
• Lower threshold for oral antibiotics

Immunocompromised Patients

• More aggressive treatment approach 1
• Lower threshold for oral antibiotics
• Closer follow-up

Prevention Strategies

• Keep hands and feet dry, avoid prolonged water exposure 1
• Wear gloves while cleaning or doing wet work 1
• Apply daily topical emollients to cuticles and periungual tissues 1
• Proper nail trimming to avoid trauma 1
• Cut toenails straight across rather than curved 1
• File nail surfaces with an emery board after softening in warm water 1
• For recurrent cases: Consider urea-based cream to reduce nail thickness 1

Follow-up and Monitoring

• Regular follow-up every 2-4 weeks until resolution for chronic paronychia 1
• Return within 48-72 hours if signs of infection are present 1
• Monitor for complications including permanent nail deformity, secondary infection, and permanent onycholysis 1

When to Seek Medical Evaluation

• Abscess formation
• Signs of spreading infection
• Systemic symptoms
• Immunocompromised status
• Failure to improve with home treatment 1

Treatment Algorithm

1. Assess for abscess: If present → surgical drainage + culture
2. No abscess:
   • Acute paronychia → warm soaks + topical antibiotics with steroids
   • Chronic paronychia → identify and remove irritants + topical steroids
3. Evaluate for fungal involvement: If present → add appropriate antifungal therapy
4. Monitor response: If no improvement within 48-72 hours → reassess and consider oral antibiotics

For occupational chronic paronychia, a combination of insulating polymer, antifungals (octopirox and climbazole), and anti-inflammatory agents has shown promising results with 86.6% of patients showing cure or improvement 3.