Narrative review of acute and chronic paronychia of the hand, covering anatomy, microbiology, differential diagnosis (including herpetic whitlow and periungual malignancy), and nonsurgical and surgical management strategies for both presentations. Addresses when to drain, what antibiotics to use, and how to approach refractory chronic cases.
When you see chronic nail fold inflammation lasting >6 weeks, first-line treatment is topical corticosteroid plus irritant avoidance — not antifungals — because the evidence shows Candida is a secondary colonizer driving inflammation rather than the primary pathogen.
When surgical drainage of acute paronychia reveals subungual spread or when chronic cases fail conservative care, adding nail removal to tissue excision significantly reduces recurrence.
Narrative review of acute and chronic paronychia of the hand, covering anatomy, microbiology, differential diagnosis (including herpetic whitlow and periungual malignancy), and nonsurgical and surgical management strategies for both presentations. Addresses when to drain, what antibiotics to use, and how to approach refractory chronic cases.
When you see chronic nail fold inflammation lasting >6 weeks, first-line treatment is topical corticosteroid plus irritant avoidance — not antifungals — because the evidence shows Candida is a secondary colonizer driving inflammation rather than the primary pathogen.
When surgical drainage of acute paronychia reveals subungual spread or when chronic cases fail conservative care, adding nail removal to tissue excision significantly reduces recurrence.