What is the initial management of an acute paronychia?

• A. Broad-spectrum antibiotics alone
• B. Incision and drainage
• C. Topical antifungal
• D. Observation only

Answer: (B)

Drainage of a purulent collection around the nail fold is the initial management. When an abscess has formed, removing the pus and releasing the built-up pressure directly addresses the main problem and allows healing to begin. This is done with a small, sterile incision under local anesthesia to evacuate the pus, followed by wound care and a dressing. After drainage, warm soaks and proper daily care help the area recover. Antibiotics are added if there is spreading cellulitis, systemic illness, diabetes, or immunosuppression, but antibiotics alone won’t resolve an established abscess. Topical antifungals aren’t appropriate for an acute bacterial paronychia, and observing without drainage risks progression.