From the Guidelines
Paronychia treatment should prioritize drainage, especially for acute cases, and may involve topical or oral antibiotics for bacterial infections, or antifungal medications for fungal infections, as evidenced by the most recent guidelines 1. The treatment approach for paronychia depends on the severity and cause of the infection. For mild acute paronychia, warm water soaks for 15 minutes, 3-4 times daily, can help drain pus and reduce inflammation. If there's an abscess, it may require drainage by lifting the nail fold away from the nail plate with a sterile instrument. Some key considerations in managing paronychia include:
- Keeping the affected area dry, especially for chronic cases
- Avoiding nail biting, finger sucking, and aggressive manicuring, as these can worsen the condition
- Considering the use of topical povidone iodine 2%, topical antibiotics/corticosteroids, or oral antibiotics for more severe infections, as suggested by recent guidelines 1
- For fungal paronychia, antifungal medications like clotrimazole 1% cream or ketoconazole 2% cream applied twice daily for 2-4 weeks are recommended, based on earlier studies 1 It's also important to note that if diabetes or immunocompromise is present, more aggressive treatment may be necessary, and medical attention should be sought promptly as infections can spread more rapidly in these individuals. Recent guidelines propose a grading system for paronychia severity, which can help guide treatment decisions, including the use of topical or oral antibiotics, and in severe cases, surgical intervention or partial nail avulsion 1.
From the Research
Treatment Options for Paronychia
- Warm soaks with or without Burow solution or 1% acetic acid are recommended for acute paronychia 2
- Topical antibiotics should be used with or without topical steroids when simple soaks do not relieve the inflammation 2
- Oral antibiotics are usually not needed if adequate drainage is achieved unless the patient is immunocompromised or a severe infection is present 2
- For chronic paronychia, treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 2
- Avoiding exposure to contact irritants and using a combination of a broad-spectrum topical antifungal agent and a corticosteroid can be beneficial for chronic paronychia 3
Surgical Intervention
- Surgical incision and drainage may be required for more severe cases of acute paronychia 3
- An intra-sulcal approach is preferable to a nail fold incision for surgical drainage of an abscess 4
- En bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail removal, may be performed for recalcitrant chronic paronychia 3