Paronychia Management Guidelines

Appropriate Specialist Referral Pathway

• The American College of Dermatology and podiatry societies recommend referral to dermatology or podiatry when paronychia does not improve after 2 weeks of appropriate treatment, rather than general surgery 1, 2
• Hand surgery consultation should be considered specifically for severe or treatment-refractory cases of finger paronychia requiring advanced surgical intervention 2
• For toenail paronychia with complications, podiatry consultation is the preferred specialty given their expertise in nail fold pathology and surgical techniques specific to the foot 1

Treatment Algorithm Before Considering Any Specialist

• Conservative management with topical antiseptics, topical corticosteroids, and antiseptic soaks is recommended for Grade 1-2 Paronychia (Mild to Moderate), with addition of oral antibiotics if infection is suspected 1, 3, 4
• Reassessing after 2 weeks of conservative management is crucial to determine the need for specialist referral 1, 3

Key Clinical Pitfalls

• Avoid reflexive general surgery referral for paronychia, as this condition is managed primarily by dermatology and podiatry, with hand surgery reserved for complex finger cases requiring advanced reconstruction 1, 2