Paronychia Treatment Overview

When you may need a healthcare provider

If you have been doing warm salt water or white vinegar soaks and applying topical antibacterial treatments for 2–3 days and it is not getting better, see a healthcare provider.

You should also see a provider if the skin around the nail is becoming more swollen or painful, or is redder.

If you have a weakened immune system (from medication, cancer, or an organ transplant) or diabetes and you have a paronychia, get immediate care.

Get immediate care if you have a fever or a collection of pus (an abscess) under the skin or nail that is not draining.

What to expect from your visit

If you have paronychia with a collection of pus (an abscess), your doctor will make an incision and drain it using a local numbing agent (anesthetic). They may send a culture of the pus to the laboratory to find out which bacteria or fungus is causing the paronychia.

You may also be prescribed a topical or oral prescription antibiotic. You should see an  improvement in 24–48 hours after starting the medicine. Make sure you finish the complete course of medicine even if it looks like the infection has gone away. If you don't notice improvement in 24–48 hours, call your provider. They may need to try a different antibiotic or re-examine the paronychia.

Chronic paronychias are harder to treat. You may be given a prescription topical or oral antifungal medication. It could take 2–3 weeks to notice an improvement in redness, scaling, and tenderness of the surrounding nail skin. Sometimes, a combination of antifungal and steroid cream is needed. You’ll also be advised to avoid getting the area wet, and to avoid any possible irritants or allergens.

Prescription paronychia medications

• Bactroban ointment (mupirocin)
• Cephalexin (Keflex)
• Doxycycline
• Sulfamethoxazole-Trimethoprim (Bactrim)
• Ketoconazole cream
• Econazole cream
• Betamethasone/clotrimazole cream (lotrisone cream)
• Fluconazole (Diflucan)

Types of providers

• A primary care provider can treat mild to moderate symptoms.
• A dermatologist, a skin doctor, can also diagnose and treat paronychia.

How to treat paronychia at home

If you have symptoms of paronychia (nail infection), like redness, swelling, and pain around the skin of the nail, you can usually treat it at home. You should notice improvement in 2–3 days of home care.

• Soak your finger in warm salt water for 20–30 minutes, 2–4 times a day. This should draw the pus to the top of the skin and also relieve discomfort.
• You can also use white vinegar soaks (1 part vinegar to 1 part water) to soak your finger. This may help reduce bacteria in the skin.
• You can apply an OTC antibiotic ointment like Bacitracin to the infected skin.
• You can take OTC pain relievers like Tylenol or Motrin for pain. Put a bandage on the infected skin.

If the skin around your fingernails is red, scaly, and irritated, you may have chronic paronychia. Try to avoid exposing the infected skin to water. Wear gloves when hands will be in water, like washing the dishes. Avoid direct contact with any possible allergens or irritants.

You can also try an OTC antifungal cream or topical steroids. If it does not get better in 2–3 weeks, see a healthcare provider.

OTC medications

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Bacitracin (antibiotic cream)
• Terbinafine cream (Lamisil)
• Clotrimazole cream (Lotrimin)
• Hydrocortisone cream 1% (Cortaid or Cortizone)

Wellness and prevention

You can prevent paronychia by protecting the delicate skin around the nails.

• Only go to nail salons that have very good cleaning and sterilization or bring your own tools.
• When you are getting a manicure, ask them not to cut your cuticles.
• If you often get nail infections, wear gloves when hands will be in water. Moist skin is more likely to become infected.