When candidiasis is suspected, the area should be kept dry and treated with local applications of nystatin or other topical antifungals. A long course of systemic medication may be required. Followup with a podiatrist is important. A more aggressive approach, and one more likely to be successful, is to sharply excise the entire wedge of affected nail, nailbed and lateral skin fold down to the periosteum of the distal phalynx. Instruct the patient to soak the toe in warm water for 20 min bid and arrange for multiple followup visits.
Extensive paronychia requires excision of the entire nail.
Instruct the patient to soak the finger in warm water for ten minutes qid and consider prescribing antibiotics for three or four days. Keep the needle or scalpel tip flat against the dorsal surface of the nail. There is no need to make an incision through the skin and thus a digital block is usually not necessary. Debride any periungual pustules. Instruct the patient in warm soaks at least qid.