From the Guidelines
To treat paronychia, the most effective approach is to start with gentle skin care and topical treatments, such as topical povidone iodine 2% and topical antibiotics/corticosteroids, and escalate to oral antibiotics or surgical intervention if necessary, as recommended by the Annals of Oncology guidelines 1. The treatment of paronychia depends on the severity of the infection, which can be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
- For Grade 0 prevention, gentle skin care instructions, such as wearing comfortable shoes, wearing gloves while cleaning, and avoiding biting nails or cutting nails too short, are recommended, along with the use of antimicrobial soaps and daily application of topical emollients to cuticles and periungual tissues 1.
- For Grade 1 treatment, continuing the current drug dose and monitoring for change in severity, along with topical povidone iodine 2% and topical antibiotics/corticosteroids, is suggested 1.
- For Grade 2 treatment, continuing the current drug dose and monitoring for change in severity, along with topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, is recommended 1.
- For Grade 3 (or intolerable Grade 2) treatment, interrupting the drug until the reaction resolves, obtaining bacterial/viral/fungal cultures if infection is suspected, and continuing treatment with topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, or considering partial nail avulsion, is advised 1. It is essential to reassess the patient after 2 weeks and adjust the treatment plan accordingly, as some cases may require dose interruption or discontinuation of the offending drug 1.
From the Research
Treatment for Paronychia
There are no research papers directly related to the treatment of paronychia (infection of the nail bed) in the provided evidence. However, some studies discuss the treatment of related conditions, such as onychomycosis (nail fungal infections) and skin infections.
Related Conditions and Treatments
- Onychomycosis treatment options include:
- Skin infections, such as streptococcal and staphylococcal infections, can be treated with antibiotics like cephalexin 4
- Topical antibiotics, such as bacitracin, neomycin, and polymyxin B, can be used to control microbial colonization and prevent infections 5
Limitations
The provided evidence does not directly address the treatment of paronychia, and therefore, no specific treatment recommendations can be made based on these studies 6, 5, 3, 2, 4