From the Guidelines
For paronychia that has persisted for 8 days, I recommend continuing the drug at the current dose and monitoring for change in severity, while also applying topical povidone iodine 2% and topical antibiotics/corticosteroids, as outlined in the ESMO clinical practice guidelines 1. This approach is based on the guidelines for Grade 1 and Grade 2 treatment of paronychia, which suggest continuing the drug at the current dose and monitoring for change in severity, while also applying topical treatments such as povidone iodine 2% and topical antibiotics/corticosteroids 1. Some key points to consider in the treatment of paronychia include:
- Avoiding repeated friction and trauma/excessive pressure on the affected area
- Using antimicrobial soaks and washing with cleansers and water
- Applying topical emollients to cuticles and periungual tissues
- Considering oral antibiotics if infection is suspected, as outlined in the guidelines for Grade 2 treatment 1. It is also important to note that paronychia can progress to more severe forms, including the formation of friable granulation tissue on the lateral folds of the nail, and that secondary bacterial or mycological superinfections can occur in up to 25% of cases 1. Therefore, close monitoring and reassessment after 2 weeks is crucial to determine the effectiveness of the treatment and to adjust the treatment plan as needed 1.
From the FDA Drug Label
A small amount of mupirocin ointment should be applied to the affected area three times daily. Patients not showing a clinical response within 3 to 5 days should be re-evaluated.
The patient has had paronychia for 8 days, which is beyond the 3 to 5 days timeframe for expected clinical response.
- The patient should be re-evaluated as they have not shown a clinical response within the expected timeframe 2.
From the Research
Treatment for Paronychia
For an 8-day treatment of paronychia, the following options are available:
- Warm soaks with or without Burow solution or 1% acetic acid 3
- Topical antibiotics with or without topical steroids when simple soaks do not relieve the inflammation 3, 4
- Determining the presence of an abscess, which mandates drainage 3
- Oral antibiotics are usually not needed if adequate drainage is achieved unless the patient is immunocompromised or a severe infection is present 3
Chronic Paronychia Treatment
For chronic paronychia, treatment options include:
- Stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors 3, 5
- Using a combination of a broad-spectrum topical antifungal agent and a corticosteroid 4
- Application of emollient lotions may be beneficial 4
- Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia 4, 5
- En bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal, may be performed in recalcitrant cases 4, 5
Newer Therapies
Newer therapies, such as a combination of topical medications including an insulating polymer, topical antifungals, and a molecule with anti-inflammatory activity, have shown efficacy and tolerability in the treatment and prevention of moderate and chronic paronychia 6