What is the treatment for paronychia?

Paronychia Treatment

The treatment of paronychia should focus on warm soaks with antiseptic solution (10-15 minutes, 2-3 times daily), topical corticosteroids for inflammation, and surgical drainage for abscesses, with treatment approach varying based on whether the condition is acute or chronic. 1

Classification and Diagnosis

Paronychia is an inflammation of the nail folds that can be classified as:

• Acute paronychia: Typically caused by polymicrobial infections after breach of the protective nail barrier 2
• Chronic paronychia: Defined by symptoms lasting at least six weeks, representing an irritant dermatitis 2

Treatment Algorithm

Acute Paronychia Treatment

1. Conservative Management (First-Line)

   • Warm soaks with antiseptic solution for 10-15 minutes, 2-3 times daily 1
   • 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 for inflammation 1

2. Abscess Management

   • Surgical drainage is mandatory for abscesses 1
   • Drainage options range from using a hypodermic needle to wide incision with a scalpel 2
   • Intra-sulcal approach is preferable to nail fold incision 3

3. Antibiotic Therapy

   • Oral antibiotics usually not needed if adequate drainage is achieved 2
   • Exception: Immunocompromised patients or severe infections 2
   • Therapy should be based on likely pathogens and local resistance patterns 2

Chronic Paronychia Treatment

1. Eliminate Causative Factors

   • Identify and remove irritants (acids, alkalis, chemicals) 2
   • Keep hands/feet dry and avoid prolonged water exposure 1
   • Wear gloves while cleaning or doing wet work 1

2. Topical Treatments

   • Mid to high-potency topical corticosteroids 1, 2
   • Calcineurin inhibitors as alternative 2
   • Daily topical emollients to cuticles and periungual tissues 1

3. For Fungal Involvement

   • Topical antifungals (imidazoles) 1
   • Oral fluconazole for Candida species 1
   • Itraconazole for resistant cases 1

4. Advanced Interventions

   • More aggressive techniques may be required to restore the protective nail barrier 2
   • Consider dermatology consultation 3

Special Considerations

Diabetic Patients

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

Immunocompromised Patients

• May require more aggressive treatment approach 1
• Lower threshold for oral antibiotics 1

Follow-Up Care

• Regular follow-up every 2-4 weeks until resolution 1
• Return immediately if signs of infection develop 1
• Monitor for complications including permanent nail deformity, secondary infection, and permanent onycholysis 1

Common Pitfalls to Avoid

1. Failure to drain abscesses when present, which is mandatory for proper treatment 1
2. Overuse of oral antibiotics when adequate drainage would suffice 2
3. Overlooking chronic irritants in cases of chronic paronychia 2
4. Missing unusual causes such as malignancy in unresponsive chronic cases 3
5. Inadequate follow-up, especially in high-risk patients such as those with diabetes 1

Patient education is essential to reduce recurrence of both acute and chronic paronychia 2. Treatment of chronic paronychia may take weeks to months to achieve complete resolution 2.