Management

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.

Reference:

• (1) Rigopoulos D et al. Acute and Chronic Paronychia. AFP 2008; 77(3)