New York State Medical Treatment Guidelines for Paronychia in workers compensation patients

The guidelines presented by the New York State Workers Compensation Board aim to support physicians, podiatrists, and other healthcare professionals in delivering suitable treatment for Paronychia.

These guidelines from the Workers Compensation Board are designed to aid healthcare professionals in determining the optimal level of care for individuals with ankle and foot disorders.

It’s essential to note that these guidelines do not replace clinical judgment or professional expertise. The final decision regarding care should be a collaborative one, involving the patient and their healthcare provider.



Paronychia refers to an inflammatory condition affecting the nail folds. There are two main categories: acute and chronic. Acute paronychia typically arises from injury to the cuticle or nail folds.


Medications for Paronychia

Pain Management for Paronychia:

Ibuprofen, naproxen, or other NSAIDs from earlier generations are recommended as initial treatments for most patients. In cases where NSAIDs are not suitable, acetaminophen (or paracetamol) may be a viable alternative, although research indicates it may be slightly less effective than NSAIDs.

There is evidence supporting that NSAIDs are as effective in pain reduction as opioids like tramadol, with lower associated risks.

NSAIDs for Paronychia Pain:

NSAIDs are recommended for alleviating pain associated with paronychia.

Indications: Treatment with NSAIDs is suggested for paronychia pain. Initial use of over-the-counter (OTC) medications is advisable to gauge effectiveness. As needed, ongoing use may be appropriate for many patients.

Indications for Discontinuation: Discontinuation criteria include resolution of ankle/foot discomfort, ineffectiveness, or the emergence of side effects necessitating cessation.

NSAIDs for High-Risk Patients of Gastrointestinal Bleeding:

NSAIDs are recommended for patients at high risk of gastrointestinal bleeding, and concurrent use of misoprostol, sucralfate, histamine type 2 receptor blockers, and proton pump inhibitors is advised.

Indications: Consider cytoprotective drugs for patients with a high-risk factor profile who need NSAIDs, especially for prolonged treatment. Individuals with a history of gastrointestinal bleeding, the elderly, diabetics, and smokers are at risk.

Frequency/Dose/Duration: Use H2 blockers, misoprostol, sucralfate, and proton pump inhibitors with dosage guidance from the manufacturer. Generally, there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

Indications for Discontinuation: Discontinuation is recommended in case of intolerance, the emergence of adverse effects, or when stopping NSAIDs is necessary.

NSAIDs for Patients at Risk of Cardiovascular Adverse Effects:

First-line treatment options, such as acetaminophen or aspirin, are recommended as they appear to be safer in terms of cardiovascular side effects. Non-selective NSAIDs are advised if necessary, in preference to COX-2-specific medications.

NSAIDs should be used cautiously in patients taking low-dose aspirin for cardiovascular disease prevention to minimize the risk of adverse effects. Patients with a history of cardiovascular disease or multiple risk factors should discuss the pros and cons of NSAID use for pain relief.

Acetaminophen for Paronychia Pain:

Acetaminophen is recommended for treating paronychia pain, especially in patients with NSAID contraindications.

Indications: Appropriate for acute, subacute, chronic, and postoperative patients with foot/ankle pain.

Dose/Frequency: Follow the manufacturer’s recommendations; can be used as needed. Caution is advised against exceeding four gm/day due to evidence of liver toxicity.

Indications for Discontinuation: Discontinuation criteria include resolution of pain, adverse effects, or intolerance.

Topical Antibiotics for Acute Paronychia:

Topical antibiotics are recommended for treating severe acute paronychia.

Systemic Antibiotics for Complications of Paronychia:

Systemic antibiotics are recommended for treating paronychia-related complications, such as cellulitis or symptoms of a systemic infection.

Topical and Systemic Antifungals for Chronic Paronychia (Fungal Infections):

Topical and systemic antifungals are recommended for treating persistent paronychia caused by fungal infections.

Topical Glucocorticosteroid Cream for Chronic Paronychia (Non-Bacterial/Fungal):

Topical glucocorticosteroid cream is recommended for treating chronic paronychia in select patients not caused by bacterial or fungal infections.

Topical and Systemic Antibiotics for Secondary Chronic Paronychia (Bacterial Infections):

Topical and systemic antibiotics are recommended for treating secondary chronic paronychia caused by bacterial infections.


Treatment for Paronychia

Warm Compresses for Treating Acute Paronychia:

The use of warm compresses is recommended for the treatment of severe acute paronychia.

Rationale: Warm compresses can help alleviate symptoms and promote drainage, providing relief during the acute phase of paronychia. This simple and non-invasive approach may aid in reducing inflammation and discomfort associated with the condition.


Surgery for Paronychia

En Bloc Excision of the Proximal Nail Fold and Eponychial Marsupialization, With or Without Nail Plate Removal:

This surgical procedure is recommended for the permanent resolution of recurrent paronychias.

Surgical Management for Chronic Paronychia After Non-Operative Failures:

For cases where non-operative measures prove ineffective in treating chronic paronychia, surgical management is recommended. This may involve en bloc excision of the proximal nail fold and eponychial marsupialization, with or without the removal of the nail plate.

Incision and Drainage of Abscess in Response to Acute Paronychia:

In cases of severe paronychia leading to abscess formation, incision and drainage are recommended for therapeutic intervention.

What our office can do if you have Paronychia

We’ve got the expertise to assist you with your workers’ compensation injuries. We grasp the challenges you’re facing, and we’ll address your medical requirements in line with the regulations outlined by the New York State Workers Compensation Board.

Recognizing the significance of your workers’ compensation cases, we’re here to guide you through the complexities of liaising with the workers’ compensation insurance company and your employer.

We acknowledge the stress you and your family are going through at this time. If you’re looking to set up an appointment, reach out to us, and we’ll strive to simplify the process as much as we can for you.


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