From the Guidelines
Paronychia is an infection of the skin around the nail, characterized by redness, swelling, pain, and sometimes pus collection, and its treatment involves topical and oral antibiotics, as well as drainage, with the most recent and highest quality study recommending topical povidone iodine 2% and topical antibiotics/corticosteroids for grade 1 treatment, and oral antibiotics for grade 2 treatment 1.
Diagnosis of Paronychia
The diagnosis of paronychia is based on the severity of the infection, which can be graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0, with grade 0 being prevention, grade 1 being mild, grade 2 being moderate, and grade 3 being severe 1. The symptoms of paronychia include nail fold oedema or erythema, disruption of the cuticle, and pain, with or without discharge or nail plate separation.
Treatment of Paronychia
The treatment of paronychia depends on the severity of the infection, with the following recommendations:
- For grade 1 treatment, topical povidone iodine 2% and topical antibiotics/corticosteroids are recommended 1.
- For grade 2 treatment, topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics are recommended 1.
- For grade 3 treatment, interrupting the treatment until the infection resolves, obtaining bacterial/viral/fungal cultures, and continuing treatment with topical povidone iodine 2%/topical beta-blocking agents/topical antibiotics and corticosteroids and/or oral antibiotics, and considering partial nail avulsion are recommended 1.
Prevention of Paronychia
Prevention of paronychia is also important, with the following recommendations:
- Gentle skin care instructions, wearing comfortable shoes, wearing gloves while cleaning, and avoiding biting nails or cutting nails too short are recommended 1.
- Preventive correction of nail curvature, avoiding repeated friction and trauma/excessive pressure, using antimicrobial soaks and washing with cleansers and water, and daily application of topical emollients to cuticles and periungual tissues are also recommended 1.
- Biotin to improve nail strength is also recommended 1.
From the Research
Diagnosis of Paronychia
- Paronychia is an inflammation of the folds of tissue surrounding the nail of a toe or finger, which can be classified as either acute or chronic 2, 3, 4.
- Acute paronychia is mainly caused by polymicrobial infections after the protective nail barrier has been breached, while chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens 3, 4.
- The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold, enabling pathogens to inoculate the nail, resulting in infection 4.
Treatment of Acute Paronychia
- Treatment options for acute paronychia include warm-water soaks, oral antibiotic therapy, and surgical drainage 2.
- Warm soaks with or without Burow solution or 1% acetic acid can be used, along with topical antibiotics and topical steroids when simple soaks do not relieve the inflammation 3.
- The presence of an abscess should be determined, which mandates drainage, and oral antibiotics are usually not needed if adequate drainage is achieved unless the patient is immunocompromised or a severe infection is present 3.
Treatment of Chronic Paronychia
- Treatment of chronic paronychia is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 3.
- Topical antifungal agents and steroids can be used, and surgical intervention may be required in some cases 2, 4.
- Patient education is paramount to reduce the recurrence of acute and chronic paronychia, and general preventive measures form the cornerstone of therapy 3, 5.
- In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal 4, 5.