Treatment of Chronic Paronychia

First-Line Treatment Approach

The American College of Dermatology recommends applying mid-to-high potency topical corticosteroid ointment to nail folds twice daily, combined with topical 2% povidone-iodine applied twice daily, for the treatment of chronic paronychia 1
Warm water soaks for 15 minutes, 3-4 times daily, or white vinegar soaks (1:1 dilution) for 15 minutes daily, are recommended to reduce inflammation and prevent secondary bacterial or fungal superinfection 1
Wearing protective gloves during wet work is advised to prevent ongoing irritant exposure 1, 2

Up to 25% of chronic paronychia cases develop secondary bacterial or fungal superinfections, and topical azoles or polyenes are effective for candidal involvement 1
Keeping the infected area dry is crucial as moisture promotes candidal growth 1
Oral fluconazole 50 mg daily or 300 mg weekly for a minimum of 4 weeks is recommended for severe candidal involvement with nail changes 3
Itraconazole 200 mg daily or pulse therapy (400 mg daily for 1 week per month) is first-line for Candida onychomycosis when systemic therapy is needed 3

Any abscess requires drainage, ranging from needle instrumentation to wide incision with scalpel 1
Partial nail plate avulsion is recommended for intolerable grade 2 or grade 3 paronychia with pyogenic granuloma 1

Terbinafine can aggravate psoriasis, so if systemic antifungal therapy is needed, itraconazole or fluconazole is preferred 4
Daily application of topical emollients to cuticles and periungual tissues is recommended to maintain skin barrier function 1, 5

Reassessing after 2 weeks of treatment is recommended to evaluate response 1, 2
Avoiding nail biting and cutting nails too short, and trimming nails straight across, is advised for long-term prevention 1, 5
Applying emollients daily to cuticles and periungual tissues is recommended to maintain barrier integrity 1, 5