Treatment

Treatment depends on the degree of inflammation

If an abscess is not present

• warm water compresses and soaking the affected finger in Burrow's solution (i.e., aluminium acetate) or vinegar may be helpful
• paracetamol or a nonsteroidal anti-inflammatory drug - for symptomatic treatment In mild cases: For persistent lesions:
  • antibiotic cream e.g. fusidic acid cream,
  • antibiotic cream + a topical corticosteroid e.g. fusidic acid plus hydrocortisone
    • combination treatment is a safe and effective way to treat uncomplicated acute bacterial paronychia and appear to be more effective than topical antibiotics alone (1)
  • oral anti-staphylococcal antibiotic therapy (e.g. flucloxacillin if not penicillin allergic), OR,
  • broad-spectrum oral antibiotic e.g. co-amoxiclav (if not penicillin allergic) for people who are exposed to oral flora

Surgical treatment may be required if abscess is present (1):

• superficial infections - drained with a size 11 scalpel or a comedone extractor (1)
• elevating the nail fold with the tip of a 21- or 23-gauge needle, followed immediately by passive oozing of pus from the nail bed (1)
• if pus is visible and extends away from the nail fold, it may be incised at this site
• pus trapped beneath the nail requires excision of the proximal third of the nail with elevation of the paronychia; the paronychia is often held open by interposing gauze. The gauze is removed after 2-3 day
• an alternative for extensive infection is removal of the entire nail bed with paronychial elevation
  
  
• post-operatively, the hand should be dressed with gauze and movement encouraged

Reference:

1. Leggit JC. Acute and chronic paronychia. Am Fam Physician. 2017 Jul 1;96(1):44-51.