Guideline sources The following summarized guidelines for the evaluation and management of paronychia are prepared by our editorial team based on guidelines from the American Association of Family Physicians (AAFP 2017). 1 Guidelines 1. Diagnostic investigations Ultrasound: consider ultrasound in patients with paronychia to determine the presence of an abscess or cellulitis when it is not clinically evident. C 2. Medical management Topical corticosteroids: add topical steroids to topical antibiotics to decrease the time to symptom resolution in patients with acute paronychia. B Oral antibiotics: do not use oral antibiotics if an abscess has been appropriately drained. D Topical anti-inflammatory agents: use topical anti-inflammatory agents for the treatment of patients with chronic paronychia. B Antifungals: do not use antifungals for the treatment of patients with paronychia. D https://web.pathway.md/diseases/recGUIc2iltSSr2QO 1/2 6/29/23, 10:53 PM Paronychia Pathway 3. Patient education Irritant avoidance: advise patients with paronychia to avoid irritants. B 4. Follow-up and surveillance Prevention of recurrent paronychia: Advise the following measures to prevent recurrent paronychia: apply moisturizing lotion after hand washing avoid chronic prolonged exposure to contact irritants and moisture (including detergent and soap) avoid nail trauma, biting, picking, and manipulation, and finger sucking avoid trimming cuticles or using cuticle removers improve glycemic control in patients with diabetes mellitus keep affected areas clean and dry keep nails short provide adequate patient education use rubber gloves, preferably with inner cotton glove or cotton liners when exposed to moisture and/or irritants. B Clinical findings Symptoms Integument exam Finger discharge Beau's lines Finger pain Finger erythema Hangnail picking Finger swelling Nail biting Fluctuance of paronychium Ingrown nail Nail discoloration Nail grooving Nail thickening Nailfold swelling References 1. Jeff C Leggit. Acute and Chronic Paronychia. Am Fam Physician. 2017 Jul 1;96 1 44 51. Open https://web.pathway.md/diseases/recGUIc2iltSSr2QO 2/2