Management of Finger Paronychia
The management of finger paronychia should be based on severity, with mild cases treated using warm water or vinegar soaks, topical antiseptics and steroids, while moderate to severe cases may require antibiotics and surgical drainage. 1
Assessment and Classification
- Evaluate severity based on redness, edema, discharge, and presence of granulation tissue 1
- Check for presence of pus or abscess formation which would necessitate drainage 1
- Assess for predisposing factors such as nail trauma, excessive moisture exposure, or chemical irritants 1, 2
Treatment Algorithm by Severity
Grade 1 (Mild) Paronychia
- Implement warm water soaks for 15 minutes 3-4 times daily or white vinegar soaks (1:1 white vinegar:water) for 15 minutes daily 1, 3
- Apply topical 2% povidone-iodine twice daily to the affected area 1
- Use mid to high potency topical steroid ointment to nail folds twice daily to reduce inflammation 1, 4
Grade 2 (Moderate) Paronychia
- Continue conservative measures as for mild cases 1
- Start oral antibiotics if signs of infection are present 1
- Apply combination of topical steroids, antifungals, antibiotics and/or antiseptics 1, 5
Grade 3 (Severe) Paronychia with Abscess
- Obtain culture of any purulent discharge to guide antibiotic therapy 1
- Perform surgical drainage of abscess - options range from using a hypodermic needle to lift the nail fold to more extensive incision with a scalpel 1, 6
- Prescribe appropriate antibiotics based on likely pathogens and local resistance patterns 1, 4
Special Considerations for Chronic Paronychia
- Apply high-potency topical corticosteroids which have been found more effective than antifungals in chronic cases 1, 7
- Consider intralesional triamcinolone acetonide for recalcitrant cases 1, 3
- Topical timolol 0.5% gel twice daily under occlusion has shown benefit in some cases 1, 3
- Treatment may take weeks to months for chronic cases 4
Prevention of Recurrence
- Keep hands as dry as possible; avoid prolonged soaking in water 1, 2
- Avoid nail trauma/injury and cutting nails too short 1, 2
- Moisturize hands regularly with emollients applied to cuticles and periungual tissues 1, 2
- Wear protective gloves during wet work or exposure to irritants 1, 2
Common Pitfalls and Caveats
- Don't overlook potential secondary bacterial or fungal superinfections, which are present in up to 25% of cases 1
- Oral antibiotics are usually not needed if adequate drainage is achieved unless the patient is immunocompromised or has a severe infection 4
- Patient education is crucial to reduce recurrence of both acute and chronic paronychia 4
- Chronic paronychia often has a multifactorial etiology and may require addressing underlying causes such as occupational exposures 8, 7