I have had paronychia on and off despite using multiple medications for years. What should I do?

Q. What is the effective treatment for swollen and painful fingernails that resist various therapies?

Answered by
Dr. Suvash Sahu
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 15, 2023 and last reviewed on: Jan 19, 2023

Hello doctor,

I do not know what to do about my infected cuticles (paronychia). I have had paronychia on and off for years. Each time I got it, a doctor treated it, and it was healed in a few weeks. I have had one to two fingers inflamed, painful, infected and swollen this time. The doctors have prescribed me, Azithromycin, Cefdinir, Gentamicin ointment, Sulfamethoxazole, Fluconazole, and Omnicef. I have tried over-the-counter medications and all-natural remedies (apple cider vinegar soaking, tea tree oil application). Nothing has worked. They hurt so bad. They are so swollen and painful. Both middle fingers are red, and the throbbing middle fingertip on the right hand has grown to two times the size of all my fingers. The nail is deformed, and the fingertip looks giant. What else should I do?

Kindly help.

Thank you.



Welcome to icliniq.com.

I read your query and understand your concern.

It seems that you are suffering from paronychia with maybe ingrown nails. Paronychia is a soft tissue infection around a fingernail that begins as cellulitis but may progress to a definite abscess. Acute paronychia is a painful and purulent condition, most frequently caused by Staphylococci. Chronic paronychia is usually caused by a fungal infection (six months). It would be best if you did gram staining or culture to rule out the bacterial cause, and potassium hydroxide (KOH) 5% smears rule out the fungal cause. If soft tissue swelling is present without fluctuance, the infection may resolve with warm soaks three to four times daily. If an abscess has developed, incision and drainage must be performed. For the acute episode, you can take oral antibiotics like Augmentin 625 mg thrice daily (if not sensitive to Penicillin) with topical Fusidic Acid cream plus Clotrimazole cream twice daily for five days. Do not cut toenails from the side. You can cut from the front and side nails once they grow, pinch the skin, and cause recurrent problems. Consult a specialist doctor, talk with them, and take medications with their consent. Review after five days.

Thank you.

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