What should I do for redness and swelling of the toenail fold (paronychia)?

Paronychia—the inflammation of the nail fold surrounding a fingernail or toenail—is commonly caused by bacterial infection (often *Staphylococcus aureus* or *Streptococcus pyogenes*), minor trauma (e.g., aggressive nail trimming, ingrown nails, or repeated moisture exposure), or fungal involvement (especially in chronic cases). When affecting the toe, it typically presents with localized erythema, swelling, tenderness, and warmth along one or both lateral nail folds; pus may accumulate beneath the cuticle or at the nail margin.

For mild, early-stage paronychia without fluctuant abscess or systemic symptoms (e.g., fever, lymphangitis), conservative management is appropriate: soak the affected toe in warm, sterile saline or diluted antiseptic solution (e.g., 1:10 dilution of povidone-iodine) for 15–20 minutes two to three times daily. Keep the area clean and dry between soaks, avoid further trauma or nail manipulation, and wear well-fitting, breathable footwear to reduce pressure and moisture. Over-the-counter topical antibiotics (e.g., mupirocin ointment) may be considered, though evidence supporting their efficacy in uncomplicated cases is limited.

If signs of progression emerge—including increasing pain, spreading erythema, fluctuance, purulent drainage, or systemic symptoms—prompt medical evaluation is essential. A healthcare provider may perform incision and drainage under local anesthesia if an abscess is present. Oral antibiotics (e.g., cephalexin, dicloxacillin, or clindamycin in penicillin-allergic patients) are indicated for moderate-to-severe infection or cellulitis extension. In recurrent or chronic cases (>6 weeks), fungal culture and potassium hydroxide (KOH) preparation should be performed to rule out *Candida* or dermatophyte infection, which may require antifungal therapy (e.g., terbinafine or itraconazole).

Prevention focuses on proper nail hygiene: trim nails straight across, avoid cutting cuticles or pushing back eponychium, wear protective gloves during wet work, and manage underlying conditions such as diabetes or immunosuppression that increase susceptibility. Patients with persistent or recurrent paronychia should be evaluated for predisposing factors including psoriasis, lichen planus, or occupational exposures.