Treatment of Paronychia

Classification and Assessment

Evaluate severity of paronychia based on parameters including redness, edema, discharge, and granulation tissue 1
Check for presence of pus or abscess formation which would require drainage 1
Assess for predisposing factors such as ingrown toenail (onychocryptosis) 1

For Grade 1 (Mild) Paronychia, implement warm water soaks for 15 minutes 3-4 times daily or white vinegar soaks (1:1 white vinegar:water) for 15 minutes daily 2, 3
Apply topical 2% povidone-iodine twice daily to the affected area 1
Use mid to high potency topical steroid ointment to nail folds twice daily to reduce inflammation 1
For Grade 2 (Moderate) Paronychia, start oral antibiotics if signs of infection are present 3, 1
Apply topical very potent steroids, antifungals, antibiotics and/or antiseptics (preferably as combination preparations) 3
For Grade 3 (Severe) Paronychia, swab any pus for culture and prescribe appropriate antibiotics 3
Consider surgical intervention for drainage or partial nail avulsion 3, 1

For Chronic Paronychia, apply high-potency topical corticosteroids which have been found more effective than antifungals in chronic cases 1
Consider intralesional triamcinolone acetonide for recalcitrant cases 1
Topical timolol 0.5% gel twice daily under occlusion has shown benefit in some cases 1

Keep hands and feet as dry as possible; avoid prolonged soaking in water 2, 3
Avoid nail trauma/injury and cutting nails too short 2, 1
Moisturize hands and feet regularly with emollients applied to cuticles and periungual tissues 2, 1
Wear protective gloves during wet work or exposure to irritants 1
Wear comfortable well-fitting shoes that protect nails without being restrictive 2, 3

Reassess after 2 weeks of treatment 1
If no improvement is seen, consider referral to dermatology or podiatry for further evaluation 1

Don't overlook potential secondary bacterial or mycological superinfections, which are present in up to 25% of cases 1