From the Guidelines
Treatment of paronychia should be guided by the severity of the condition, with mild cases (Grade 1) managed with topical povidone iodine 2% and topical antibiotics/corticosteroids, while more severe cases (Grade 2 or 3) may require oral antibiotics and/or surgical intervention, as recommended by the most recent guidelines 1.
Overview of Paronychia Treatment
The treatment approach for paronychia is multifaceted and depends on the severity of the condition, which can be classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. The guidelines emphasize the importance of gentle skin care, prevention of trauma, and the use of antimicrobial soaks and topical emollients to prevent the progression of paronychia.
Treatment by Severity
- For Grade 0 prevention, measures include gentle skin care instructions, wearing comfortable shoes, avoiding biting nails or cutting them too short, and the daily application of topical emollients to cuticles and periungual tissues, as well as biotin to improve nail strength 1.
- Grade 1 treatment involves continuing the drug at the current dose and monitoring for changes in severity, with the application of topical povidone iodine 2% and topical antibiotics/corticosteroids. Reassessment after 2 weeks is crucial to determine if the reaction has worsened or improved 1.
- For Grade 2 treatment, the approach includes continuing the drug at the current dose, monitoring for changes in severity, and obtaining bacterial/viral/fungal cultures if infection is suspected. Topical povidone iodine 2%, topical beta-blocking agents, topical antibiotics, and corticosteroids, and/or oral antibiotics may be used. Reassessment after 2 weeks is necessary to evaluate the need for further intervention 1.
- Grade 3 (or intolerable Grade 2) treatment requires interrupting the drug until the condition improves to Grade 0/1, obtaining cultures if infection is suspected, and considering surgical intervention or antibiotics. Topical povidone iodine 2%, topical beta-blocking agents, topical antibiotics, and corticosteroids, and/or oral antibiotics may be used, with reassessment after 2 weeks to determine if dose interruption or discontinuation is necessary 1.
Key Considerations
- The pathogenesis of paronychia involves the inhibition of the epidermal growth factor receptor (EGFR) and downstream pathways, leading to altered differentiation and migration of epidermal cells, which can result in periungual inflammation 1.
- Secondary bacterial or mycological superinfections are present in up to 25% of cases, highlighting the need for antimicrobial treatments in some cases 1.
- The use of silver nitrate solution for granulation tissue and povidone-iodine ointment, as well as considering oral antibiotics based on resistance results, are important considerations in the management of paronychia, especially in more severe cases or when superinfection is suspected 2.
Conclusion is not allowed, so the answer just ends here.
From the Research
Treatment Guidelines for Paronychia
The treatment guidelines for paronychia, an infection of the nail fold, can be categorized into acute and chronic paronychia.
- Acute paronychia is typically caused by polymicrobial infections and can be treated with: + Warm soaks with or without Burow solution or 1% acetic acid 3 + Topical antibiotics with or without topical steroids 3, 4 + Oral antibiotics may be necessary if the patient is immunocompromised or has a severe infection 3 + Drainage of abscesses, which can be done through instrumentation with a hypodermic needle or a wide incision with a scalpel 3, 4
- Chronic paronychia is characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier 3. + Treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 3 + Avoiding exposure to contact irritants and using a combination of a broad-spectrum topical antifungal agent and a corticosteroid may be beneficial 4 + Application of emollient lotions and topical steroid creams may also be effective 4 + In recalcitrant chronic paronychia, en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail removal, may be performed 4
Special Considerations
- Antibiotic-resistant acute paronychia may be caused by other infectious and noninfectious problems, such as viruses, fungi, drugs, and trauma 5
- Cytologic examination with Tzanck smear may be useful diagnostically and may prevent unnecessary use of antibiotics and surgical drainage 5
- Paronychia associated with epidermal growth factor (EGFR) inhibitor therapy may require a different approach, with empirical oral antibiotic treatment using oral cephalosporines, ciprofloxacin, levofloxacin, or moxifloxacin 6