Paronychia Empiric Therapy 

Updated: Feb 06, 2017
Author: Manuel Valdebran, MD; Chief Editor: Thomas E Herchline, MD 

Empiric Therapy Regimens

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]

Acute paronychia

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.

Chronic paronychia

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:

  • Tacrolimus ointment applied to affected area(s) BID