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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The management of chronic paronychia involves:

  • dipstix urine to exclude covert diabetes mellitus
  • if history is suggestive, swab for vaginal candidosis
  • taking swabs and scrapings for exact diagnosis
  • advise the patient to avoid exposure to contact irritants or getting their hands wet
  • emollient lotions – lubricating the nascent cuticle and the hands is usually helpful
  • topical anticandidal preparation such as:
    • miconazole cream packed into the nail fold
    • clotrimazole solution applied to nail fold
  • the first line of treatment in patients with chronic paronychia should be topical steroids
  • a combination of topical steroids and antifungal agents can be used in simple chronic paronychia as an alternative therapy
  • systemic corticosteroids – can be used for a limited period of time in severe paronychia involving several fingernails
  • systemic antifungals – can be sued in a trial basis for patients who do not respond to topical treatment and other preventive measures (1)
  • if pus is present it can often be released by simply lifting the nailfold from the nail; otherwise, it must be incised. Sometimes a portion of the nail needs to removed as detailed for acute paronychia.

 

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