From the Guidelines
Paronychia treatment involves a combination of topical and oral therapies, as well as lifestyle modifications.
Treatment Options
- For mild cases (Grade 0-1), treatment includes gentle skin care, topical emollients, and antimicrobial soaps, as well as avoiding irritants and trauma 1.
- For moderate cases (Grade 2), treatment involves topical povidone iodine, topical antibiotics, and corticosteroids, as well as oral antibiotics if infection is suspected 1, 2.
- For severe cases (Grade 3-4), treatment may require interruption or discontinuation of EGFR inhibitor therapy, surgical intervention, and systemic antibiotics 1, 2.
Important Considerations
- Drainage is a crucial aspect of paronychia treatment, especially in cases of abscess formation 3, 4.
- Topical povidone iodine and silver nitrate can be effective in reducing granulation tissue and preventing infection 1, 2.
- Oral antibiotics should be considered in cases of suspected bacterial superinfection, with the choice of antibiotic guided by culture results 2.
- Lifestyle modifications, such as avoiding irritants, wearing gloves, and keeping the area dry, can help prevent paronychia and promote healing 1, 5.
From the Research
Treatment Options for Paronychia
The treatment for paronychia can be classified into two main categories: acute and chronic paronychia.
- For acute paronychia, treatment options include: + Warm compresses 6, 7, 8 + Topical antibiotics, with or without corticosteroids 6, 8 + Oral antibiotics 6, 7, 8 + Surgical incision and drainage for more severe cases 9, 6, 7, 8
- For chronic paronychia, treatment options include: + Avoiding exposure to contact irritants 6, 8, 10 + Topical antifungal agents and corticosteroids 6, 7, 10 + Application of emollient lotions 6 + Topical steroid creams, which are more effective than systemic antifungals 6, 10 + Surgical treatment, such as en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail removal 6, 10
Surgical Treatment
Surgical treatments aim to cure paronychia by exposing the inflamed germinal matrix to permit unrestricted drainage 9.
- A Swiss roll technique can be used for the treatment of chronic and severe acute paronychia 9
- En bloc excision of the proximal nail fold is an option for recalcitrant chronic paronychia 6, 10
- Eponychial marsupialization, with or without nail removal, may be performed in recalcitrant cases 6, 10
Patient Education
Patient education is paramount to reduce the recurrence of acute and chronic paronychia 8.