Paronychia: Treatment Options and Pain Management

Issues related to paronychia?

Hello Doctor, last week I experienced an issue with paronychia for the first time, which was very red, swollen, and painful.
Initially, I only disinfected the wound with Betadine, and later I trimmed a little myself, but it didn't seem to completely resolve.
Since the clinic was closed for the holiday, I went to the emergency room.
The doctor mentioned that paronychia doesn't necessarily require nail removal and prescribed me tetracycline ointment to apply to the wound.
There has been some improvement, but I noticed that some polyps have developed in the area of the paronychia (https://imgur.com/a/BwKfD).
I have attached a picture and would like to ask if I need to have these removed at the clinic, or will they fall off on their own? Are there any less painful treatment options available?

Jason, 10~19 year old female. Ask Date: 2016/04/07

Dr. Li Zhonghuai reply Surgery

Hello! I have reviewed the image.
The presence of polyps indicates ongoing irritation.
It is recommended to remove one-quarter of the nail on the side affected by paronychia.
I suggest consulting a general surgeon for treatment in the operating room under local anesthesia.
Some doctors may advise taking anti-inflammatory medications and antibiotics for observation, but since it has already been a week, delaying further will only increase your discomfort.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2016/04/07

More Info

Paronychia is an infection of the skin around the nails, often resulting in redness, swelling, and pain. It can be caused by bacteria, fungi, or trauma to the nail area. Your experience with paronychia, especially as a first-time occurrence, can be quite distressing. It’s good to hear that you initially sought treatment and have been using antiseptics and topical antibiotics as advised.

In terms of treatment options for paronychia, there are several approaches depending on the severity and duration of the infection. Since you mentioned that you have already been prescribed a topical antibiotic (tetracycline ointment), this is a common first-line treatment for mild cases. However, if the infection persists or worsens, further intervention may be necessary.

1. Observation and Home Care: For mild cases, keeping the area clean and dry is crucial. Continue using antiseptics like iodine and avoid any further trauma to the area. Soaking the affected finger in warm, soapy water can also help reduce swelling and promote drainage.

2. Topical Antibiotics: As you have experienced, topical antibiotics can be effective in treating superficial infections. If you notice no improvement after a few days or if the condition worsens, it may be time to consult a healthcare provider again.

3. Incision and Drainage: If there is an accumulation of pus or if the infection is severe, a healthcare provider may need to perform an incision and drainage (I&D) procedure. This is typically done under local anesthesia and can provide immediate relief from pain and pressure.

4. Oral Antibiotics: In cases where the infection is more extensive or if there are signs of systemic infection (such as fever), oral antibiotics may be prescribed.
5. Surgical Intervention: Regarding the growth of what you described as "polyps" around the nail area, it’s essential to have these evaluated by a healthcare professional. While some benign growths may resolve on their own, others may require surgical removal, especially if they are causing discomfort or are recurrent.
6. Pain Management: For pain management, over-the-counter pain relievers such as ibuprofen or acetaminophen can be helpful. If the pain is severe, your doctor may prescribe stronger pain medication.

7. Follow-Up Care: It’s crucial to follow up with a healthcare provider, especially if you notice any changes in the appearance of the nail or surrounding skin, or if the pain and swelling do not improve. A healthcare provider can assess whether the growths are indeed polyps or if they are related to the infection.

In summary, while some cases of paronychia can resolve with conservative treatment, others may require more invasive procedures. It’s essential to monitor your symptoms closely and seek further medical advice if necessary. If you are concerned about the growths around your nail, it would be advisable to consult with a dermatologist or a healthcare provider who can provide a thorough evaluation and recommend the best course of action.

Similar Q&A

Best Medications for Treating Erythrodermic Psoriasis

Which medication has the best therapeutic effect?

Dr. Chen Yiying reply Dermatology
Hello: In response to your question, there are many causes of paronychia. When it is due to a bacterial infection, antibiotics are required. If it is caused by long-term irritation, topical steroids should be used. In cases where there is an ingrown nail, surgical intervention ma...

Recommended Topical Treatments for Paronychia: What to Use?

Paronychia, I found out at home that the doctor prescribed two types of oral medications, but the topical medication that was mentioned was not provided. Could you recommend a topical medication for me?

Dr. Chen Jiaming reply Surgery
The localized tissue inflammation (often infectious) caused by the nail results in swelling and pain. Therefore, oral medications primarily consist of antibiotics and anti-inflammatory pain relievers, while topical ointments are mostly antibiotic-containing creams (commonly known...

Managing Nail Fold Inflammation and Dyshidrotic Eczema: Treatment Options

I'm sorry, doctor. I would like to ask about my ongoing issue with paronychia, which has been complicated by herpetic eruptions. I previously had orthodontic treatment elsewhere, but recently I've experienced another flare-up of paronychia, and the herpetic eruptions ke...

Dr. Wu Yuxin reply Dermatology
The effects of braces are not long-lasting; I recommend consulting an orthopedic surgeon for corrective surgery.

Understanding Paronychia: Treatment Options and Common Misconceptions

What is paronychia and how is it treated? Why do some doctors say that medication is sufficient while some family members suggest nail removal?

Dr. Huang Zhihui reply Surgery
Paronychia is usually caused by trauma or ingrown nails, leading to a bacterial infection of the nail fold and subsequent inflammation. Mild cases can be treated with antibiotics or incision and drainage, while severe cases may require nail removal or even destruction of the nail...