What is the treatment for paronychia?

Treatment of Paronychia

The treatment for paronychia should include warm soaks with antiseptic solutions, topical antibiotics with steroids for inflammation, and surgical drainage if an abscess is present. 1

Acute Paronychia Treatment

First-line Management

• Keep nails short and clean
• Apply warm soaks with antiseptic solutions (2-3 times daily)
• Daily dilute vinegar soaks (50:50 dilution) to nail folds twice daily as a non-antibiotic approach 1
• Topical antibiotics with steroids for inflammation 1
  • Mupirocin ointment applied to affected area three times daily 2
  • Mid to high-potency topical corticosteroid ointment for inflammation 1

When to Escalate Treatment

• If abscess is present: Surgical drainage is mandatory 1
• Drainage options range from using a hypodermic needle to a wide incision with a scalpel 3
• Patients not showing clinical response within 3-5 days should be re-evaluated 2
• Oral antibiotics are usually unnecessary if adequate drainage is achieved, except in:
  • Immunocompromised patients
  • Severe infections 3

Chronic Paronychia Treatment

• High-potency topical corticosteroids alone or combined with topical antibiotics 1
• For fungal involvement:
  • Topical antifungals (imidazoles) 1
  • Oral fluconazole for Candida species 1
  • Itraconazole for resistant cases 1
• Treatment may take weeks to months 3
• Address underlying causes (remove irritants, avoid prolonged water exposure)

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
• Earlier consideration of oral antibiotics

Prevention Strategies

• Apply daily topical emollients to periungual folds, matrix, and nail plate 1
• Wear cotton gloves during wet work 1
• Avoid nail trauma 1
• Keep hands and feet dry 1
• Proper nail trimming (straight across rather than curved) 1
• Regular follow-up every 2-4 weeks until resolution 1

Follow-up Recommendations

• Return within 48-72 hours if signs of infection are present 1
• Follow-up within 1-2 weeks to ensure proper healing 1
• Monitor for complications including:
  • Permanent nail deformity
  • Secondary infection
  • Permanent onycholysis 1

Common Pitfalls to Avoid

• Delayed treatment can lead to chronic onycholysis, nail bed keratinization, and persistent subungual hyperkeratosis 1
• Failing to identify and address the underlying cause in chronic paronychia
• Overlooking the need for drainage when an abscess is present
• Not considering fungal causes in chronic cases
• Inadequate patient education about prevention strategies

Patient education is critical to prevent recurrence of both acute and chronic paronychia, particularly for those in high-risk occupations involving frequent water exposure 3.