Chronic paronychia is an infection of the skin surrounding the nail lasting more 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:
Avoidance of irritants and finger trauma: use hypoallergenic products, dye and perfume free, avoid prolonged water exposure, and avoid nail trauma
Hydrocortisone cream: Topical steroids are the standard recommendation for chronic paronychia. Use hydrocortisone 1% ointment (FDA M017) on the affected area daily for up to 3 weeks.
Second-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 white vinegar and water has additional antimicrobial benefits.
Zinc supplementation: Zinc deficiency is known to cause soft and fragile nails, nail plate abnormalities, and chronic paronychia. 20 mg zinc daily supplements have been observed to improve symptoms.
Prescription medications:
Calcineuron inhibitors: Anti-inflammatory medications that have shown to be superior for chronic paronychia than animicrobials. In a randomized, unblinded, comparative study, tacrolimus 0.1% (Protopic) was more effective than betamethasone 17-valerate 0.1%.
Oral antibiotics: No longer part of general management; only used in specific circumstances.
Surgery: Proximal nail fold and nail plate excision may be indicated in refractory cases
Citation
Leggit, J. C. (2017). Acute and chronic paronychia. American family physician, 96(1), 44-51.
Iorizzo M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015;33(2):175-183.
