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I have seen a 30 year old woman today who has suffered with paronychia to her left hallux. 6 week history, 2 courses of fluclox from GP have failed to resolve. Recent GP swab negative (false neg perhaps as at time wound was dry?). In the past it has exudated pus, and she reports that the nail has stopped growing. She is otherwise fit and well, no ongoing meds. She is due to travel to the US on Sunday for 2 week work trip and GP does not want to further prescribe Fluclox in absence of positive swab. I have suggested she returns to GP for topical steroid cream, and obtain further prescription for antibiotics, particularly if she is going to be in US. Advised further to avoid enclosed shoes.
My questions are:
1. Is there anything else conservative that should be considered.
2. Would this presentation suggest removal of the existing nail is necessary.
3. Can a diagnosis or retronychia only be made once the nail is removed, so that any new nail growth below can be considered?
Many thanks

 

Given the upcoming trip, yes, she needs to find a way to at least getting the antibiotics.