In the case of a severely infected great-toe paronychia, does it matter whether or not you start antibiotics before you perform partial nail removal?
—Gregory H. Tuttle, MD, Chapel Hill, N.C.

Paronychia is an often tender infection or inflammation around the base of the nail fold. It can start suddenly (acute paronychia) or gradually (chronic paronychia). In a patient with an acute paronychia of the great toe, nail removal is not necessarily required. If the proximal nail fold is fluctuant, incision and drainage should be performed prior to the start of antibiotic therapy. If it is not fluctuant, oral therapy alone may be sufficient. In chronic paronychia, antibiotic therapy is not indicated. Treatment of the infection is usually with a topical cream or lotion. Frequently prescribed medications may include a topical antifungal and/or a topical steroid.
— Jeffrey M. Weinberg, MD