From the Guidelines
For treating erythema of the proximal nail fold and absence of cuticle, I recommend applying topical povidone iodine 2% and topical corticosteroids, as suggested by the most recent guidelines 1.
Treatment Approach
The treatment approach should focus on reducing inflammation and preventing infection.
- Apply topical povidone iodine 2% to the affected area, as it has antimicrobial properties and can help prevent infection.
- Use a topical corticosteroid, such as a mid to high potency topical steroid ointment, to reduce inflammation and edema.
- Additionally, daily dilute vinegar soaks to the nail folds twice daily can be beneficial in reducing inflammation and preventing infection 1.
Management
It is essential to manage the condition properly to prevent further complications.
- Keep the area dry and avoid manipulating the cuticle or nail fold.
- Soak the affected finger in warm water with a teaspoon of salt for 5-10 minutes daily, followed by gentle drying.
- Apply petroleum jelly to the area after medication application to maintain moisture.
- If no improvement occurs within 2 weeks, or if there are signs of bacterial infection (increased pain, purulent discharge), seek medical attention as oral antibiotics may be needed.
Prevention
Proper nail care is essential for prevention and treatment.
- Avoid water immersion and irritants like harsh soaps.
- Wear comfortable shoes and gloves while cleaning to prevent repeated friction and trauma.
- Avoid biting nails or cutting nails too short, and use antimicrobial soaps and cleansers to prevent infection 1.
From the Research
Topical Treatment for Erythema of the Proximal Nail Fold and Absence of Cuticle
- The condition described is similar to chronic paronychia, which is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens 2, 3.
- Topical steroid creams have been found to be more effective in the treatment of chronic paronychia than systemic antifungals 2, 3.
- Application of emollient lotions may be beneficial in the treatment of chronic paronychia 2.
- In the case of erythema of the proximal nail fold and absence of cuticle, a broad-spectrum topical antifungal agent and a corticosteroid may be used as treatment 2.
- However, it is essential to note that topical medicaments, including antibiotics and antifungals, can cause allergic contact dermatitis 4.
- A non-antibiotic, petrolatum-based ointment may be a suitable alternative for wound care, as it has been shown to provide equivalent efficacy for wound healing as a combination antibiotic first-aid ointment, without the risk of allergic contact dermatitis 5.