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Key sources
The following summarized guidelines for the evaluation and management of paronychia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2019; 2017).


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.
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  • Culture

2.Medical management

Topical corticosteroids: add topical steroids to topical antibiotics to decrease the time to symptom resolution in patients with acute paronychia.

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  • Oral antibiotics

  • Topical anti-inflammatory agents

  • Antifungals

3.Patient education

Irritant avoidance: advise patients with paronychia to avoid irritants.

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