Acute paronychia is an infection of the skin surrounding the nail lasting less than 6 weeks, often caused by bacteria or fungi. It can be acute (usually bacterial) or chronic (often fungal). Treatment focuses on reducing infection, managing pain, and addressing the underlying cause.
First-line recommendations:
Warm soaks: Soak the affected finger or toe in warm water 2-4 times daily for 15-20 minutes to reduce swelling and promote drainage. Alternatively, soaking with Burow’s Solution or 1:1 dilution of All natural distilled white vinegar and water has additional antimicrobial benefits.
Antibiotic ointment: Apply to the infected area 2-3 times daily after soaking. bacitracin/neomycin/polymyxin B (Neomycin Antibiotic Ointment) is a popular over-the-counter antibiotic ointment but has been found to cause allergic skin reactions in 10% of people. Alternatively, a bacitracin-polymyxin B combination (Polysporin Antibiotic Skin Ointment) can be used.
Hydrocortisone cream: Addition of topical steroids has been shown in randomized double-blind clinical trials to decrease the time to symptom resolution without additional risks. Use hydrocortisone 1% and apply along with antibiotic ointment. Hydrocortisone 1% cream.
Prescription medications:
Prescription antibiotic ointment: Mupirocin, gentamicin, or floroquinolones for broader coverage or specific organisms.
Oral antibiotics (e.g., cephalexin or clindamycin): For severe cases with spreading cellulitis or abscess formation.
Professional procedures:
Incision and drainage: May be needed for abscess formation, performed by a healthcare professional.
Citation
Leggit, J. C. (2017). Acute and chronic paronychia. American family physician, 96(1), 44-51.
