Goals

To treat infection and relieve pain and inflammation of the superficial soft tissue of a nail fold.

Background

Paronychia is a superficial infection and inflammation in the lateral or proximal nail folds of the fingers or toes. Paronychia can be acute or chronic, with chronic presentations lasting for longer than six weeks and affecting multiple digits at one time. Acute paronychia is typically due to infection, whereas chronic paronychia is largely due to irritants.

Patients with acute paronychia present with acute onset of pulsating pain, swelling, and erythema of a nail fold. Risk factors include artificial nails, manicures, manipulation of a hangnail, ingrown nails, nail biting, and occupations with frequent exposure to moisture and/or irritants. The most common causative organism is Staphylococcus aureus, but can also include Pseudomonas and Streptococcus species, and other gram-negative or anaerobic bacteria. Treatment is based on the degree of inflammation and the presence of an abscess. Mild inflammation can be treated with warm soaks 3 to 4 times per day to encourage spontaneous drainage and topical antibiotics such as mupirocin. If the condition does not improve within two to three days or an abscess is present, it should be opened to allow for drainage. This module will focus on the management of acute paronychia where incision and drainage are required.

Contraindications

None

Caution in patients with diabetes or immunosuppression.