Treatment depends on the degree of inflammation
If an abscess is not present
- warm water compresses and soaking the affected finger in Burow's solution (i.e., aluminum acetate) or vinegar may be helpful
- paracetamol or a nonsteroidal anti-inflammatory drug - for symptomatic treatment In mild cases: For persistent lesions:
- antibiotic cream e.g. fusidic acid cream,
- antibiotic cream + a topical corticosteroid e.g. fusidic acid plus hydrocortisone
- combination treatment is a safe and effective way to treat uncomplicated acute bacterial paronychia and appear to be more effective than topical antibiotics alone (1)
- oral antistaphylococcal antibiotic therapy (e.g. flucloxacillin if not penicillin allergic), OR,
- broad-spectrum oral antibiotic e.g. co-amoxiclav (if not penicillin allergic) for people who are exposed to oral flora
Surgical treatment may be required if abscess is present (1):
- superficial infections - drained with a size 11 scalpel or a comedone extractor (1)
- elevating the nail fold with the tip of a 21- or 23-gauge needle, followed immediately by passive oozing of pus from the nail bed (1)
- if pus is visible and extends away from the nail fold, it may be incised at this site
- pus trapped beneath the nail requires excision of the proximal third of the nail with elevation of the paronychia; the paronychia is often held open by interposing gauze. The gauze is removed after 2-3 day
- an alternative for extensive infection is removal of the entire nail bed with paronychial elevation
- post-operatively, the hand should be dressed with gauze and movement encouraged
Reference:
- 1. Rigopoulos D et al. Acute and Chronic Paronychia. AFP 2008; 77(3)