New York State Medical Treatment Guidelines

for Paronychia in workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Paronychia.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Paronychia

An inflammatory condition of the nail folds is called paronychia. Acute and chronic conditions are the two main categories. Injury to the cuticle or nail folds results in acute instances.

Medications for Paronychia

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are equally effective at reducing pain as opioids, such as tramadol, and less dangerous.

  1. NSAIDs for Treatment of Paronychia Pain

    NSAIDs for Treatment of Paronychia Pain is recommended in order to reduce paronychia pain.

    Indications:Treatment with NSAIDs is advised for paronychia pain. First, try over-the-counter (OTC) medications to see whether they work. As required, use may be appropriate for many patients.

    Indications for Discontinuation: Resolution of ankle/foot discomfort, ineffectiveness, or emergence of side effects requiring termination.

     

  2. NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding is recommended Patients who are at a high risk of gastrointestinal bleeding should take misoprostol, sucralfate, histamine type 2 receptor blockers, and proton pump inhibitors concurrently.

    Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is Recommended the first-line treatment options of acetaminophen or aspirin seem to be the safest in terms of cardiovascular side effects. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

    NSAIDs should be used with caution in patients taking low-dose aspirin for the main or secondary prevention of cardiovascular disease in order to reduce the risk that they will have an adverse effect.

    Patients who have a history of cardiovascular disease or who have many cardiovascular risk factors should discuss the benefits and drawbacks of NSAID medication for pain.

     

  4. Acetaminophen for Treatment of Paronychia Pain

    Acetaminophen for Treatment of Paronychia Pain is recommended for the treatment of paronychia pain, especially in patients who have NSAID contraindications.

    Indications: Acute, subacute, chronic, and postoperative patients with foot/ankle pain.

    Dose/Frequency:As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

    Indications for Discontinuation:Resolution of pain, unpleasant effects or intolerance.

     

  5. Topical Anitbiotics for the Treatment of Acute Paronychia

    Topical Anitbiotics for the Treatment of Acute Paronychia is recommended in order to treat severe paronychia.

     

  6. Systemic Antibiotics for the Treatment of Complications of Paronychia

    Systemic Antibiotics for the Treatment of Complications of Paronychia is recommended for the treatment of paronychia-related problems, such as cellulitis or symptoms of a systemic infection.

     

  7. Topical and Systemic Antifungals for the Treatment of Select Patients with Chronic Paronychia Due to Fungal Infections

    Topical and Systemic Antifungals for the Treatment of Select Patients with Chronic Paronychia Due to Fungal Infections is recommended in order to treat persistent paronychia

     

  8. Topical Glucocorticosteroid Cream for Treatment of Select Patients with Chronic Paronychia Not Due to Bacterial or Fungal Infections

    Topical Glucocorticosteroid Cream for Treatment of Select Patients with Chronic Paronychia Not Due to Bacterial or Fungal Infections are recommended for treatment of select patients with chronic paronychia with chronic paronychia not due to bacterial or fungal Infections.

     

  9. Topical and Systemic Antibiotics for Treatment of Secondary Chronic Paronychia Due to Bacterial Infections

    Topical and Systemic Antibiotics for Treatment of Secondary Chronic Paronychia Due to Bacterial Infections is recommended for the treatment of chronic paronychia infections that are secondary.

Treatment for Paronychia

Warm Compresses to Treat Acute Phase of Paronychia

Warm Compresses to Treat Acute Phase of Paronychia is recommended in order to treat severe paronychia.

Surgery for Paronychia

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

    En Bloc Excision of the Proximal Nail Fold and Eponychial Marsupialization, With or

    Without Nail Plate Removal is recommended to cure paronychias that come back repeatedly.

     

  2. Surgical Management for Treatment of Chronic Paronychia for Those Who Fail Non-Operative Measures

    Surgical Management for Treatment of Chronic Paronychia for Those Who Fail Non-Operative Measures Is recommended for the treatment of chronic paronychia, surgery is used, including en bloc excision of the proximal nail fold and eponychial marsupialization, with or without nail plate removal.

     

  3. Incision and Drainage of Abscess Formed in Response to Acute Paronychia

    Incision and Drainage of Abscess Formed in Response to Acute Paronychia is recommended as a result of severe paronychia.

What our office can do if you have Paronychia

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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