From the Guidelines
Paronychia treatment should be guided by the severity of the condition, with mild cases managed with gentle skin care, topical antibiotics, and monitoring, while more severe cases may require oral antibiotics, surgical intervention, or a combination of these approaches, as recommended by the most recent guidelines 1.
Overview of Paronychia
Paronychia is an infection of the skin around the fingernail or toenail, characterized by redness, swelling, pain, and sometimes pus collection. The condition can be acute or chronic, with different management strategies for each.
Management of Paronychia
For acute paronychia, treatment involves:
- Gentle skin care instructions
- Topical antibiotics like povidone iodine 2% or topical corticosteroids
- Monitoring for change in severity
- Reassessing after 2 weeks to determine if the reaction has worsened or improved For more severe cases (Grade 2 or higher), treatment may include:
- Oral antibiotics
- Surgical intervention
- Topical beta-blocking agents
- Consideration of partial nail avulsion
Prevention of Paronychia
Prevention involves:
- Keeping nails trimmed
- Avoiding nail biting or cuticle cutting
- Wearing gloves for wet work
- Maintaining good hand hygiene
- Using barrier creams containing dimethicone
- Possibly using antifungal treatments like ketoconazole cream for chronic cases
Key Considerations
- The pathogenesis of paronychia is thought to result from inhibition of the EGFR and downstream EGFR-dependent pathways in basal and suprabasal keratinocytes, leading to altered differentiation and migration of epidermal cells 1.
- Secondary bacterial or mycological superinfections are present in up to 25% of cases, with both gram-positive and gram-negative organisms implicated 1.
- A novel scoring system comprising four parameters (redness, oedema, discharge, and granulation tissue) has been proposed to assess the severity of paronychia, although the CTCAE v5.0 grading system is commonly used 1.
From the Research
Definition and Classification of Paronychia
- Paronychia is an inflammation of the fingers or toes in one or more of the three nail folds 2, 3.
- It can be classified as either acute or chronic, with acute paronychia caused by polymicrobial infections and chronic paronychia representing an irritant dermatitis to the breached nail barrier 2, 3.
Causes and Risk Factors
- The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold, enabling pathogens to inoculate the nail and resulting in infection 3.
- Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens, with common irritants including acids, alkalis, and other chemicals used by certain professionals such as housekeepers, dishwashers, and swimmers 2, 3.
Treatment Options
- Treatment options for acute paronychia include warm compresses, topical antibiotics with or without corticosteroids, oral antibiotics, or surgical incision and drainage for more severe cases 2, 3.
- For chronic paronychia, treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors, and may require more aggressive techniques to restore the protective nail barrier 2.
- A new combination of topical medications, including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, has been shown to be effective in the treatment and prevention of moderate and chronic paronychia 4.