From the Guidelines
I recommend treating the bilateral paronychia of the right big toe with topical povidone iodine 2% and topical antibiotics/corticosteroids, as well as gentle skin care instructions, including wearing comfortable shoes and avoiding biting nails or cutting nails too short, as outlined in the most recent guidelines 1. The diagnosis of bilateral paronychia of the right big toe is typically based on clinical presentation, including nail fold oedema or erythema, disruption of the cuticle, and possible associated discharge or nail plate separation.
Key Considerations
- The severity of paronychia can be graded according to the CTCAE v5.0, with Grade 1 being the least severe and Grade 3 being the most severe 1.
- Treatment should be tailored to the severity of the condition, with Grade 1 treatment involving continuation of current medication and monitoring, and Grade 2 or 3 treatment involving topical or oral antibiotics, and possible surgical intervention or partial nail avulsion 1.
- It is essential to keep the affected area clean and dry, and to avoid manipulating or cutting the nail or surrounding tissue.
- If symptoms do not improve within 2 weeks of treatment, or if there is increasing pain, swelling, or purulent discharge, reevaluation is necessary to consider incision and drainage or culture-directed antibiotic therapy.
Treatment Options
- Topical povidone iodine 2% and topical antibiotics/corticosteroids are recommended for Grade 1 and 2 paronychia 1.
- Oral antibiotics, such as those used to treat bacterial infections, may be indicated for more severe cases or if there are signs of spreading infection.
- Surgical intervention or partial nail avulsion may be necessary for Grade 3 paronychia or if other treatments are ineffective 1.
Prevention
- Gentle skin care instructions, including wearing comfortable shoes and avoiding biting nails or cutting nails too short, can help prevent paronychia 1.
- Keeping the feet clean and dry, and avoiding excessive moisture, can also help prevent the development of paronychia.
From the Research
Diagnosis of Bilateral Paronychia of the Right Big Toe
- The diagnosis of bilateral paronychia of the right big toe involves identifying the inflammation of the folds of tissue surrounding the nail, which can be caused by direct or indirect trauma to the cuticle or nail fold, enabling pathogens to inoculate the nail and resulting in infection 2.
- Paronychia may be classified as either acute or chronic, with acute paronychia mainly due to bacterial infection, and chronic paronychia resulting from numerous conditions, including the disappearance of the cuticle and contact dermatitis 3.
- A thorough examination of the affected area is necessary to determine the presence of an abscess, which would require drainage 4.
Treatment of Bilateral Paronychia of the Right Big Toe
- Treatment options for acute paronychia include warm compresses, topical antibiotics with or without corticosteroids, oral antibiotics, or surgical incision and drainage for more severe cases 2, 4.
- For chronic paronychia, treatment involves avoiding exposure to contact irritants, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid, and applying emollient lotions 2, 5.
- Topical steroid creams have been found to be more effective than systemic antifungals in the treatment of chronic paronychia 2, 5.
- In recalcitrant cases, surgical treatment may be necessary, including en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal 2, 5.
- A new combination of topical medications, including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, has shown efficacy and tolerability in the treatment and prevention of moderate and chronic paronychia 6.