Topical Antibiotics for Paronychia Treatment
For paronychia treatment, topical povidone iodine 2% combined with topical antibiotics and corticosteroids is recommended as first-line therapy, with oral antibiotics reserved for cases with suspected infection or treatment failure. 1, 2
Treatment Algorithm Based on Severity
Mild Paronychia (Grade 1)
- Apply topical povidone iodine 2% to the affected area daily 1
- Alternate with topical antibiotics and corticosteroid combinations 1, 2
- Implement antiseptic soaks with dilute vinegar (50:50 dilution) for 10-15 minutes twice daily 1, 2
- For paronychia associated with yeast infections, alternate an imidazole lotion with an antibacterial lotion until cuticle integrity is restored 1
- Reassess after 2 weeks; if no improvement, proceed to next step 1
Moderate Paronychia (Grade 2)
- Continue topical povidone iodine 2% 1
- Apply mid to high potency topical steroid ointment to nail folds twice daily 1, 2
- If discharge is present, obtain bacterial/viral/fungal cultures 1, 2
- Consider topical beta-blocking agents (timolol 0.5% gel) for granulation tissue 1
- If infection is suspected, add oral antibiotics based on likely pathogens 1, 2
- For onychocryptosis (ingrown nail), consider dental floss nail separation or taping nail fold away from nail plate 1
Severe Paronychia (Grade 3 or intolerable Grade 2)
- Interrupt causative factors until improvement to Grade 0/1 1
- Obtain bacterial/viral/fungal cultures 1, 2
- Continue topical treatments as above 1
- Consider partial nail avulsion for severe cases 1
- For recurrent or treatment-refractory cases, consider doxycycline 100 mg twice daily 1
Special Considerations
For Candida-Associated Paronychia
- Topical imidazole lotions are first-line treatment 1
- For nail plate invasion, oral itraconazole may be considered (400 mg daily for 1 week per month for 2 months in fingernail infection) 1
- Fluconazole is an alternative if itraconazole is contraindicated 1
For Chronic Paronychia
- Identify and eliminate irritant exposures (chemicals, frequent water immersion) 2, 3
- Consider combination therapy with insulating polymer, antifungals (octopirox and climbazole), and anti-inflammatory agents 4
- For treatment-resistant cases with excessive granulation tissue, consider silver nitrate chemical cauterization 1, 2
Prevention of Recurrence
- Keep hands dry and avoid trauma to nails 2
- Wear protective gloves during activities involving water or chemicals 2
- Trim nails straight across and not too short 2
- Regular application of emollients to periungual tissues 1, 2
Common Pitfalls to Avoid
- Do not use systemic antibiotics unless infection is proven or severe 5
- Avoid prolonged use of topical steroids without addressing underlying cause 1, 2
- Don't overlook potential secondary fungal infections, which occur in up to 25% of cases 1
- Remember that paronychia can be a side effect of anticancer therapies, requiring specific management approaches 1
- Failure to identify and address predisposing factors will lead to recurrence 2, 3