From the Guidelines
Chronic paronychia of the finger is best treated with a combination of approaches, including avoiding water exposure and irritants, applying topical antifungal-steroid combinations, and considering oral antifungals or surgical intervention for more severe cases, as recommended by the most recent guidelines 1.
Treatment Approach
To manage chronic paronychia, the following steps can be taken:
- Avoid water exposure and irritants by wearing cotton-lined waterproof gloves during wet work and using barrier creams.
- Apply a topical antifungal-steroid combination such as clotrimazole 1% with betamethasone 0.05% cream twice daily for 2-4 weeks.
- For more severe cases, oral antifungals like fluconazole 150-300mg weekly for 4-6 weeks may be necessary, as suggested by earlier guidelines 1.
- If bacterial infection is suspected, topical antibiotics like mupirocin 2% ointment three times daily for 7-10 days can be added.
- Surgical intervention with partial nail plate avulsion or marsupialization may be required for recalcitrant cases, as indicated by the severity of the condition 1.
Underlying Principles
Chronic paronychia typically results from repeated minor trauma combined with moisture that disrupts the protective cuticle barrier, allowing yeast (usually Candida) and bacteria to colonize the nail fold, causing inflammation 1.
Key Considerations
- Keeping the affected area dry and avoiding nail biting or manipulation are crucial for treatment success.
- Practicing good hand hygiene is also essential to prevent the spread of infection.
- The treatment approach should be tailored to the severity of the condition, with more severe cases requiring more aggressive interventions, as outlined in the recent guidelines 1.
From the Research
Treatment Options for Chronic Paronychia of the Finger
- Topical steroid creams have been found to be more effective in the treatment of chronic paronychia 2, 3
- General preventive measures form the cornerstone of therapy, including avoiding exposure to contact irritants 2, 4, 3
- Treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid 3
- Application of emollient lotions may be beneficial 3
- In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal 2, 3
- Newer therapies, such as tacrolimus ointment 0.1%, have been found to be effective in the treatment of chronic paronychia, with a higher cure or improvement rate compared to betamethasone 17-valerate 0.1% or emollient 5
- A combination of topical medications, including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, has been found to be effective in the treatment and prevention of moderate and chronic paronychia 6
Specific Treatment Regimens
- Topical steroid creams, such as betamethasone 17-valerate 0.1%, applied twice daily for 3 weeks 5
- Tacrolimus ointment 0.1%, applied twice daily for 3 weeks 5
- A combination of topical medications, including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, applied three times a day for 2 months 6
- Oral fluconazole 100 mg, added for 20 days in cases of proven and severe candidiasis of the nails 6
- Clarithromycin 500 mg, taken twice daily for six days in cases of bacterial paronychia 6