If infection is present around the base of a toenail (paronychia), what is the recommended management prior to nail removal?

• A. Immediate nail removal with local anesthesia
• B. Start antibiotics and clear infection, then proceed
• C. Defer removal indefinitely
• D. Use topical antibiotics only

Answer: (B)

Infected tissue around the nail base should be treated to control the infection before doing a definitive nail removal. Starting systemic antibiotics helps clear the soft-tissue infection and reduces the risk of spreading it during the procedure, and any abscess should be drained to decompress the area. Once the infection is under control, nail removal can be performed more safely and healing is better. Topical antibiotics alone don’t adequately treat an active paronychia, and delaying removal indefinitely isn’t appropriate.