Paronychia Empiric Therapy 

No Results

No Results

processing….

Empiric therapeutic regimens for paronychia are outlined below, including those for acute paronychia and chronic paronychia. ^{[1, 2, 3, 4, 5, 6, 7, 8, 9, 10]}

Local care includes the use of warm compresses or soaks TID/QID if an abscess has not formed. Burow solution or vinegar soaks may be used. Avoid irritants, finger sucking, exposure to moisture, manicures, and pedicures. If abscess formation is present, incision/drainage is indicated in addition to warm soaks.

Topical antibiotics that may benefit mild cases:

Mupirocin ointment applied to affected area(s) BID/QID or

Fusidic acid ointment applied to affected area(s) BID/QID or

Gentamicin ointment applied to affected area(s) TID/QID

If exposed to oral flora (such as nail biting or thumb sucking):

Amoxicillin-clavulanate (875 mg/125 mg) PO BID or

Clindamycin 300-450 mg PO TID/QID

If not exposed to oral flora:

Cephalexin 500 mg PO TID/QID or

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO BID or

Doxycycline 100 mg PO BID or

Dicloxacillin 250 mg PO QID

Antibiotic treatment should continue for 5-7 days if incision/drainage is performed, and for 7-10 days if incision/drainage is not performed.

Data suggest that many cases of chronic paronychia are not fungal in origin and respond better to topical corticosteroid than to antifungal agents. However, in chronic cases in which fungi have been demonstrated, topical antimycotics play a role in therapy, and, if these are ineffective, systemic treatment with triazole antifungals may be used alone or in combination with topical corticosteroids or a steroid sparing-agent such as tacrolimus. In recalcitrant cases, Nd:YAG laser or surgery may be considered.

Topical antifungal therapy:

Ciclopirox suspension applied to affected area(s) BID/TID or

Clotrimazole cream applied to affected area(s) BID/TID or

Econazole cream applied to affected area(s) BID/TID or

Nystatin cream applied to affected area(s) BID/TID or

Amorolfine cream applied to affected area (s) BID/TID

Systemic antifungal therapy:

Itraconazole 200 mg PO BID

Fluconazole 150 – 300 mg PO Q Week

Topical steroid therapy (if an underlying condition exists):

Clobetasol propionate applied to affected area(s) BID or

Fluocinonide applied to affected area(s) BID or

Betamethasone dipropionate applied to affected area(s) BID or

Fluticasone propionate applied to affected area(s) BID

Calcineurin inhibitors:

Murphy-Lavoie H, Haydel MJ. Paronychia in emergency medicine. Medscape Reference. Available at http://emedicine.medscape.com/article/785158-overview. Accessed: Oct 20, 2010.

Rigopoulos D, Larios G, Gregoriou G, Alevizos A. Acute and chronic paronychia. Am Fam Physician. Feb 1 2008. 77(3):339-46.

Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol. 2002 Jul. 47(1):73-6. [Medline].

Vidimos A, Billingsley EM. Dermatologic manifestations of paronychia. Medscape Reference. Available at http://emedicine.medscape.com/article/1106062-overview. Accessed: Jun 10, 2010.

Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar. 22(3):165-74. [Medline].

Durdu M, Ruocco V. Clinical and cytologic features of antibiotic-resistant acute paronychia. J Am Acad Dermatol. 2014 Jan. 70(1):120-6.e1. [Medline].

Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar. 22(3):165-74. [Medline].

Bonifaz A, Paredes V, Fierro L, López-Lozano H, de la Herrán P, Vázquez-González D. Paronychia. Skinmed. 2013 Jan-Feb. 11(1):14-6. [Medline].

Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol. 2014 Jan. 59(1):15-20. [Medline]. [Full Text].

El-Komy MH, Samir N. 1064 Nd:YAG laser for the treatment of chronic paronychia: a pilot study. Lasers Med Sci. 2013 Dec 11. [Medline].

Manuel Valdebran, MD Junior Specialist Physician, Visiting Scholar in Dermatology/Dermatopathology, Department of Dermatology, University of California, Irvine, School of Medicine

Manuel Valdebran, MD is a member of the following medical societies: International Dermoscopy Society, Medical Dermatology Society, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Disclosure: Nothing to disclose.

Paronychia Empiric Therapy 

Research & References of Paronychia Empiric Therapy |A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us