What is the medical term for a cuticle infection and its treatment?

Medical Term and Treatment for Cuticle Infection

The medical term for a cuticle infection is paronychia, which is an inflammation of the nail folds (the tissue surrounding the nail). 1, 2

Understanding Paronychia

Paronychia occurs when the protective barrier between the nail plate and nail fold is breached, allowing organisms to invade. 3 It can be classified as:

• Acute paronychia: Typically caused by bacterial infection (most commonly Staphylococcus aureus or Streptococcus) following trauma to the nail fold 4, 5
• Chronic paronychia: An inflammatory condition lasting 6+ weeks, primarily caused by irritant contact dermatitis rather than infection, though secondary fungal colonization (especially Candida) is common 3, 6

Treatment Algorithm

For Acute Paronychia (Grade 1 - Mild)

Start with topical povidone iodine 2% twice daily as the primary antiseptic agent, combined with topical antibiotics and mid-to-high potency topical corticosteroid ointment applied to nail folds twice daily. 1, 2

• Add daily dilute vinegar soaks (50:50 dilution) to nail folds for 10-15 minutes twice daily as an adjunctive measure 1, 4
• No oral antibiotics are needed at this stage 1

For Moderate Paronychia (Grade 2)

• Continue topical povidone iodine 2% twice daily with combination topical antibiotics and corticosteroids 1, 2
• Obtain bacterial/viral/fungal cultures if infection is suspected before starting oral antibiotics 1, 4
• If infection is confirmed, use oral antibiotics: dicloxacillin 250 mg 4 times daily or cephalexin 250 mg 4 times daily as first-line 4
• For penicillin-allergic patients, use clindamycin 300-400 mg 3 times daily 4
• For suspected MRSA, use trimethoprim-sulfamethoxazole (1-2 double-strength tablets twice daily) or doxycycline 100 mg twice daily 4

For Severe Paronychia (Grade 3) with Abscess

Drainage is mandatory and the most important intervention for established abscess. 2

• Perform surgical drainage immediately 2, 3
• Consider partial nail avulsion for severe cases 1, 2
• Add oral antibiotics and/or surgical drainage as needed 1

For Chronic Paronychia

• Topical steroids (mid to high potency) are preferred to reduce inflammation 4, 6
• Apply topical povidone iodine 2% twice daily 4
• For confirmed Candida infection, use topical imidazole lotions as first-line treatment 2
• If nail plate invasion occurs, consider oral itraconazole 200 mg daily or pulse therapy 400 mg daily for 1 week per month, repeated for 2-4 months 2
• Identify and eliminate irritant exposures (water, chemicals, detergents) 2, 6

Critical Pitfalls to Avoid

• Avoid topical steroids if purulent drainage is present until infection is adequately treated 1
• Do not use terbinafine for Candida infections as it has limited and unpredictable activity 2
• Reassess after 2 weeks; if no improvement, escalate therapy or consider surgical intervention 1
• Secondary infection occurs in up to 25% of cases, involving both gram-positive and gram-negative organisms 1
• Do not overlook drug-induced paronychia, particularly from EGFR inhibitors in cancer patients, which requires different management approaches 4

Prevention Measures

• Keep hands dry and avoid trauma to nails 2
• Wear protective gloves when exposed to irritants 2
• Trim nails straight across 2
• Apply emollients to periungual tissues regularly 2