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Paronychia Treatment Overview

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Care Plan


First steps to consider

  • Most infections around the nail can be treated at home, as long as you don’t have an abscess (pocket of pus).
  • Try warm soaks 2–3 times a day, and apply an OTC antibacterial cream after soaking.
  • OTC pain relievers like Advil or Tylenol can help the pain.

When you may need a provider

  • You have an abscess with the infection—you may need antibiotics.
  • At home treatments don’t improve your symptoms in about 5 days.

Emergency Care

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Call 911 or go to the ER if you have any of the following symptoms:

  • Swelling and redness starts to move up your fingers and or toes
  • You have bone pain in the infected fingers or toes.

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All treatments for paronychia
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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.
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Frequently asked questions