Efficacy of Topical Steroidal Treatment and Hand-Care Modification in Chronic Paronychia: A Retrospective Study
Keywords:
chronic paronychia, corticosteroids, candidaAbstract
Introduction: Chronic paronychia is a persistent inflammatory condition of the periungual tissue, often triggered by excessive hand exposure to irritants. Despite its high prevalence, treatment remains challenging, with conflicting evidence on the role of microbial colonization, particularly Candida spp., and the efficacy of antifungal and antibiotic therapies.
Objectives: To assess the efficacy of topical corticosteroids combined with hand-care modifications and antimicrobial treatments in managing chronic fingernail paronychia.
Methods: This retrospective study included 97 patients (mean age 54.3 ±10.6 years, 67% female) with chronic fingernail paronychia (mean disease duration 13.3 ±6.1 years). Patients initially received antifungal and/or antibacterial therapy, followed by corticosteroid-based treatment and strict hand-care modifications.
Results: Microbial cultures identified Candida spp. in 95.9% and bacteria in 36.1% of cases. First-line antifungal and/or antibiotic therapy was largely ineffective (76.3% nonresponders). In contrast, second-line corticosteroid-based therapy (mean duration 4.0 ±0.7 months) led to improvement in 90.7% of cases, with 38.1% achieving complete or near-complete resolution. Hand-care modifications included minimizing prolonged contact with liquids, wearing non-powdered waterproof gloves for wet tasks, using mild fragrance-free cleansers, and applying moisturizer after handwashing. Treatment adherence, including these behavioral modifications (P<0.01) and regular topical application (P<0.001) as well as longer treatment duration (P<0.05), were significantly associated with improved outcome.
Conclusions: Chronic paronychia is primarily inflammatory, with limited response to antifungals or antibiotics. Prolonged corticosteroid-based therapy combined with hand-care modifications is highly effective, emphasizing the critical role of adherence to achieving clinical improvement.
References
Leggit JC. Acute and chronic paronychia. Am Fam Physician. 2017;96(1):44-51. PMID: 28671378.
Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol. 2014;59(1):15-20. DOI:10.4103/0019-5154.123482
Iorizzo M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015;33(2):175-183. DOI:10.1016/j.det.2014.12.001
Rocha BP, Verardino G, Leverone A, et al. Histopathological analysis of chronic paronychia. Int J Dermatol. 2023;62(4):514-517. DOI:10.1111/ijd.16564
Bahunuthula RK, Thappa DM, Kumari R, Singh R, Munisamy M, Parija SC. Evaluation of role of Candida in patients with chronic paronychia. Indian J Dermatol Venereol Leprol. 2015;81(5):485-490. DOI:10.4103/0378-6323.158635
Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol. 2002;47(1):73-76. DOI:10.1067/mjd.2002.122191
Rigopoulos D, Gregoriou S, Belyayeva E, Larios G, Kontochristopoulos G, Katsambas A. Efficacy and safety of tacrolimus ointment 0.1% vs. betamethasone 17-valerate 0.1% in the treatment of chronic paronychia: an unblinded randomized study. Br J Dermatol. 2009;160(4):858-860. DOI:10.1111/j.1365-2133.2008.08988.x
Ferreira Vieira d’Almeida L, Papaiordanou F, Araújo Machado E, Loda G, Baran R, Nakamura R. Chronic paronychia treatment: Square flap technique. J Am Acad Dermatol. 2016;75(2):398-403. DOI:10.1016/j.jaad.2016.02.1154
Pabari A, Iyer S, Khoo CT. Swiss roll technique for treatment of paronychia. Tech Hand Up Extrem Surg. 2011;15(2):75-77. DOI:10.1097/BTH.0b013e3181ec089e
Shemer A, Daniel R, Lyakhovitsky A, et al. Clinical significance of Candida isolation from dystrophic fingernails. Mycoses. 2020;63(9):964-969. DOI:10.1111/myc.13133
Daniel CR, Iorizzo M, Piraccini BM, Tosti A. Grading simple chronic paronychia and onycholysis. Int J Dermatol. 2006;45(12):1447-1448. DOI:10.1111/j.1365-4632.2006.03128.x
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Eran Galili, Avner Shemer, Lee Magal, Anna Lyakhovitsky , Riad Kassem, Baruch Kaplan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
