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Avoid irritants, protect nails to heal paronychia.

WHISTLER, B.C. -- Strict avoidance of irritants and scrupulous protection of the nails are the most important aspects of managing chronic paronychia, Dr. C. Ralph Daniel said at a clinical dermatology seminar sponsored by Medicis.

Treatment with topical steroids for 1-2 weeks, or with a short course of ciprofloxacin or a cephalosporin, can help, but it probably won't be completely effective unless the patient also follows an irritant avoidance regimen, said Dr. Daniel of the University of Mississippi, Jackson.

In a study of 44 people who presented to the university's dermatology clinic complaining of paronychia lasting at least 6 weeks, Dr. Daniel and his colleagues found a history of exposure to contact irritants in 93% of patients.

After treating any predisposing conditions, instruct patients to wear light cotton gloves under heavier, vinyl gloves when performing wet work, or when handling citrus fruits, tomatoes, potatoes, and other raw foods. They should also avoid direct contact with paint, paint thinner, turpentine, and similar irritating chemicals. Hands should be washed in lukewarm water with a small amount of mild soap, rinsed well, and dried gently. Cuticles should never be pushed back.

Stubborn cases often respond well to marsupialization or excision of the proximal nail fold, but patients should be warned that it will take time for the nail fold to granulate in.

The patients in the study, which was funded by Medicis, followed the avoidance regimen and applied the broad-spectrum antifungal agent ciclopirox 0.77% lotion twice a day for 6-12 weeks. This treatment was associated with 100% clearance of the paronychia. However, the study was not blinded, which was an important weakness, Dr. Daniel said.

BY NORRA MACREADY

Los Angeles Bureau
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Title Annotation:Dermatology
Author:MacReady, Norra
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1CBRI
Date:Aug 1, 2004
Words:279
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