Paronychia

ACUTE

Uncomplicated with localised pus:

• simple elevation of nail fold or puncture the fold to drain pus

• advice on hygiene

• oral antibiotics not usually necessary

• if not responding to drainage or if more extensive, use (di)flucloxacillin

• exclude diabetes

• if recurrent, consider HSV (herpetic whitlow)

CHRONIC

• Loss of cuticle is fundamental to diagnosis

• Usually due to a damaged cuticle (e.g. habit tic, excessive manicuring)

• Culture organisms

• Exclude diabetes

Attend to causation

• Minimise contact with water, soap, detergents, lipid solvents and other irritants.

• Keep hands dry (avoid wet work if possible).

• Wear cotton-lined gloves for max. 15 mins.

• Use a mild soap and shampoo.

Treatment

Topical medications to nail folds:

• 4% thymol in alcohol (SVR) qid or 10% sulfacetamide in alcohol

For Candida (if cultured):

• tincture miconazole (e.g. Daktarin bd) or clotrimazole topical preparations

Note: Vaseline and/or steroid ointment can be applied frequently when it is dry and without exudate.