Can a General Surgeon Be Consulted for Paronychia?
A general surgeon is not the appropriate specialist for routine paronychia management; dermatology, podiatry, or hand surgery are the recommended specialties for cases requiring specialist consultation. 1, 2
Appropriate Specialist Referral Pathway
When Specialist Consultation Is Needed
Dermatology or podiatry referral is recommended when paronychia does not improve after 2 weeks of appropriate treatment, rather than general surgery 1, 2
Hand surgery consultation should be considered specifically for severe or treatment-refractory cases of finger paronychia requiring advanced surgical intervention 2
For toenail paronychia with complications, podiatry consultation is the preferred specialty given their expertise in nail fold pathology and surgical techniques specific to the foot 1
Why General Surgery Is Not the Primary Choice
The evidence consistently directs referrals toward specialty-specific providers (dermatology, podiatry, hand surgery) rather than general surgery for paronychia management 1, 2
Paronychia requires nuanced understanding of nail fold anatomy and specialized techniques such as dental floss nail technique, silver nitrate cauterization, and partial nail avulsion—procedures more commonly performed by dermatologists and podiatrists 3, 1
Even when surgical drainage is required for abscess formation, the procedure is typically straightforward and can be performed by primary care, dermatology, or podiatry without requiring general surgical expertise 4, 5
Treatment Algorithm Before Considering Any Specialist
Grade 1-2 Paronychia (Mild to Moderate)
- Continue conservative management with topical povidone-iodine 2%, topical corticosteroids, and antiseptic soaks 3, 1
- Add oral antibiotics if infection is suspected (cephalexin first-line, or sulfamethoxazole-trimethoprim if MRSA suspected) 1, 6
- Reassess after 2 weeks 3, 1
Grade 3 or Intolerable Grade 2
- Consider partial nail avulsion or surgical drainage if abscess present 3
- Obtain bacterial/viral/fungal cultures if infection suspected, as up to 25% have secondary superinfections 3, 6
- If surgical intervention beyond simple drainage is needed, refer to dermatology, podiatry, or hand surgery depending on location (toe vs finger) 1, 2
Key Clinical Pitfall
Avoid reflexive general surgery referral for paronychia, as this condition is managed primarily by dermatology and podiatry, with hand surgery reserved for complex finger cases requiring advanced reconstruction 1, 2
Surgical drainage of uncomplicated paronychia does not require postoperative antibiotics in immunocompetent patients, and the procedure itself is straightforward enough for non-surgical specialists 5