Table 8.

Medical management of chronic paronychia

Medical management of chronic paronychia
A. Topical mid-potent corticosteroid ointment is applied for 2–4 weeks and repeated for flares.[2,4,28]
B. Topical broad-spectrum antifungals such as ciclopirox 0.77% topical suspension, which have a significant anti-inflammatory action have shown good results.[57]
C. Combined use of a topical anti-fungal(and topical corticosteroid has not shown to be more efficacious as compared to the use of a topical CS alone.[2,58]
D. Tacrolimus ointment is a second-line option for cases not responding to routine management and has been found to be superior to betamethasone 17-valerate or placebo (unmedicated emollient)[59] •Ointment formulation helps to restore barrier function •Active component impedes the elicitation phase of allergic contact dermatitis and prevents an irritant response.
E. Intralesional steroid injection use is indicated for resistant cases.[14,58]
F. Short course of systemic corticosteroids is recommended in patients with severe involvement of multiple digits.[5,20,58]
G. Antiseptics or antifungal lotions or solutions may be used for several months.[2,4,57]
H. Oral antifungal agent in the usual doses (itraconazole or fluconazole) is indicated if C.albicans is confirmed or in refractory cases before proceeding with an invasive procedure[2,4,31]
I. Management of chemotherapy-induced paronychia and periungual pyogenic granuloma-like lesions: propranolol 1%[60] cream, timolol 0.5% gel,[61,62,63] betaxolol 0,25% eye drops,[64] and adapalene gel.[65]