What is the best way to treat paronychia on the toe?

From the Guidelines

To treat paronychia on the toe, the best approach is to start with gentle skin care and prevention methods, such as wearing comfortable shoes, avoiding biting nails or cutting nails too short, and using antimicrobial soaks and topical emollients, as recommended by the ESMO clinical practice guidelines 1. For Grade 1 paronychia, treatment involves continuing the current treatment and monitoring for change in severity, with the addition of topical povidone iodine 2% and topical antibiotics/corticosteroids, reassessing after 2 weeks 1. Key considerations for treatment include:

• Gentle skin care instructions
• Use of antimicrobial soaks and washing with cleansers and water
• Daily application of topical emollients to cuticles and periungual tissues
• Topical povidone iodine 2% for Grade 1 treatment
• Topical antibiotics/corticosteroids for Grade 1 treatment
• Reassessment after 2 weeks to determine if the reaction has worsened or improved. For more severe cases, such as Grade 2 or 3 paronychia, treatment may involve oral antibiotics, surgical intervention, or partial nail avulsion, and should be guided by the severity of the infection and the patient's overall health 1. It is essential to note that paronychia can progress into more severe infections if not properly managed, and secondary bacterial or mycological superinfections can occur in up to 25% of cases 1. Proper nail care, including avoiding nail biting and trauma to the nail fold, can help prevent recurrence, and patients should be advised to take precautions to prevent repeated friction and trauma to the affected area 1.

From the Research

Treatment Options for Paronychia on the Toe

• For acute paronychia, treatment options include:
  • Warm compresses 2, 3
  • Topical antibiotics, with or without corticosteroids 2, 3
  • Oral antibiotics for more severe cases or if the patient is immunocompromised 2, 3
  • Surgical incision and drainage for abscesses 2, 3
• For chronic paronychia, treatment options include:
  • Avoiding exposure to contact irritants 2, 3
  • Topical broad-spectrum antifungal agents and corticosteroids 2
  • Application of emollient lotions 2
  • Topical steroid creams, which are more effective than systemic antifungals 2
  • En bloc excision of the proximal nail fold or eponychial marsupialization for recalcitrant cases 2

Important Considerations

• The presence of an abscess should be determined, and drainage is necessary 3
• Oral antibiotics are usually not needed if adequate drainage is achieved, unless the patient is immunocompromised or a severe infection is present 3
• Patient education is crucial to reduce the recurrence of acute and chronic paronychia 3
• Systemic antibiotics should not be used systematically, unless infection is proven 4