What are the recommended first-line treatments for acute paronychia in adults?

First-line treatments for acute paronychia in adults include:

• Applying moist heat (warm soaks) for 10 to 15 minutes, three to four times daily to alleviate pain and promote drainage of pus.
• Incision and drainage if a fluctuant pus collection or abscess has developed; this may be performed in primary care if expertise and facilities are available, otherwise referral is advised.
• For minor, localized infection without abscess, consider topical antibiotics such as fusidic acid cream.
• Oral antibiotics are recommended if incision and drainage is not performed, or if there is significant pain, extensive periungual tissue involvement, cellulitis, fever, or comorbidities like diabetes or immunosuppression.
• Flucloxacillin is the first-line oral antibiotic; clarithromycin is an alternative, with erythromycin preferred in pregnant or breastfeeding women.
• Self-care advice includes pain relief with paracetamol or NSAIDs, keeping the area clean and dry, avoiding trauma or manipulation of the nail, and protective measures for those frequently exposed to moist environments.

Specialist advice should be sought if MRSA infection is suspected or confirmed.

Follow-up is usually not necessary unless the condition worsens or does not improve.

¹