What is the treatment for an infected hangnail (paronychia)?

Treatment for Infected Hangnail (Paronychia)

For an infected hangnail (paronychia), the first-line treatment consists of warm antiseptic soaks 2-3 times daily, topical antibiotics with steroids for inflammation, and surgical drainage if an abscess is present. 1

Initial Management

• Warm soaks with antiseptic solution: Soak the affected finger in warm, soapy water for 10-15 minutes, 2-3 times daily 1
• Topical treatments:
  • Apply topical antibiotics combined with steroids to address both infection and inflammation 1
  • Consider dilute vinegar soaks (50:50 dilution) to nail folds twice daily as a non-antibiotic approach 1
• Pain management: Elevate the affected hand to reduce swelling and use appropriate analgesics for pain control 1

Treatment Based on Severity

Mild Paronychia (redness and swelling without pus)

• Continue warm antiseptic soaks
• Apply topical antibiotics with corticosteroids to reduce inflammation 2, 1
• Topical povidone iodine 2% can be effective 2
• Monitor for 2 weeks; if no improvement, escalate treatment 2

Moderate Paronychia (pain, swelling with possible discharge)

• Continue warm antiseptic soaks
• Apply topical antibiotics with corticosteroids
• Consider oral antibiotics if not improving with topical treatment 2, 1
• Obtain bacterial/fungal cultures if infection is suspected 2

Severe Paronychia (significant pain, pronounced inflammation with pus)

• Surgical drainage is mandatory for abscesses 1, 3
• Oral antibiotics are necessary 2, 1
• Consider partial nail avulsion if there is significant nail involvement 2

Special Considerations

• Fungal involvement: If fungal infection is suspected, topical antifungals (imidazoles) should be applied 1, 4
• Chronic cases: For persistent paronychia, consider underlying causes and treat accordingly:
  • Yeast infections may require oral fluconazole 1, 4
  • Resistant fungal cases may benefit from itraconazole 2, 1

Prevention of Recurrence

• Keep hands dry and avoid prolonged water exposure 1
• Wear gloves while cleaning or doing wet work 2, 1
• Apply daily topical emollients to cuticles and periungual tissues 2, 1
• Avoid biting nails or cutting nails too short 1

Follow-up

• Regular follow-up every 2-4 weeks until resolution 1
• Return immediately if signs of worsening infection develop (increasing pain, redness, swelling, or pus) 1
• Monitor for complications including permanent nail deformity and secondary infection 1

Common Pitfalls to Avoid

• Misdiagnosis: Viral infections like herpetic whitlow may mimic bacterial paronychia but require different treatment 3
• Inadequate drainage: Failure to properly drain an abscess can lead to persistent infection and complications 1, 3
• Overuse of antibiotics: Using antibiotics without confirming infection can lead to resistance 1
• Neglecting underlying causes: Chronic paronychia often has predisposing factors that need to be addressed 1, 4