A paronychia is a nail disease that is an often-tender bacterial or fungal infection
of the hand or foot where the nail and skin meet at the side or the base of a finger or
toenail. The infection can start suddenly or gradually. Paronychia is commonly misapplied
as a synonym for whitlow or felon.
Types
Paronychia may be divided as follows: Acute paronychia is an infection of the folds
of tissue surrounding the nail of a finger or, less commonly, a toe, lasting less than
six weeks. The infection generally starts in the paronychium at the side of the nail,
with local redness, swelling, and pain. Acute paronychia is usually caused by direct or
indirect trauma to the cuticle or nail fold, and may be from relatively minor events, such
as dishwashing, an injury from a splinter or thorn, nail biting, biting or picking at
a hangnail, finger sucking, an ingrown nail, or manicure procedures.. When no pus is present,
warm soaks for acute paronychia is reasonable, even though there is a lack of evidence to
support its use. Antibiotics such as clindamycin or cephalexin are also often used, the first
being more effective in areas where MRSA is common. If there are signs of an abscess drainage
is recommended. Chronic paronychia is an infection of the
folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting more
than six weeks. It is a nail disease prevalent in individuals whose hands or feet are subject
to moist local environments, and is often due to contact dermatitis. In chronic paronychia,
the cuticle separates from the nail plate, leaving the region between the proximal nail
fold and the nail plate vulnerable to infection. It can be the result of dish washing, finger
sucking, aggressively trimming the cuticles, or frequent contact with chemicals. Chronic
paronychia is treated by avoiding whatever is causing it, a topical antifungal, and a
topical steroid. In those who do not improve following these measures oral antifungals
and steroids may be used or the nail fold may be removed surgically.
Alternatively, paronychia may be divided as follows:
Candidal paronychia is an inflammation of the nail fold produced by Candida albicans.
Pyogenic paronychia is an inflammation of the folds of skin surrounding the nail caused
by bacteria. Generally acute paronychia is a pyogenic paronychia as it is usually caused
by a bacterial infection. Signs and symptoms
The skin typically presents as red and hot. These infections can be painful.
Pus is usually present, along with gradual thickening and browning discoloration of the
nail plate. Cause
Acute paronychia is usually caused by bacteria. Claims have also been made that the popular
acne medication, isotretinoin, has caused paronychia to develop in patients. Paronychia
is often treated with antibiotics, either topical or oral. Chronic paronychia is most
often caused by a yeast infection of the soft tissues around the nail but can also be traced
to a bacterial infection. If the infection is continuous, the cause is often fungal and
needs antifungal cream or paint to be treated. Risk factors include repeatedly washing hands
and trauma to the cuticle such as from biting. Herpes whitlows are frequently found among
dentists and dental hygienists. Prosector's paronychia is a primary inoculation of tuberculosis
of the skin and nails, named after its association with prosectors, who prepare specimens for
dissection. Paronychia around the entire nail is sometimes referred to as runaround paronychia.
Painful paronychia in association with a scaly, erythematous, keratotic rash of the ears,
nose, fingers, and toes, may be indicative of acrokeratosis paraneoplastica, which is
associated with squamous cell carcinoma of the larynx.
Paronychia can occur with diabetes, drug-induced immunosuppression, or systemic diseases such
as pemphigus. Treatment
When no pus is present warm soaks for acute paronychia is reasonable, even though there
is a lack of evidence to support its use. Antibiotics such as clindamycin or cephalexin
are also often used, the first being more effective in areas where MRSA is common. If
there are signs of an abscess drainage is recommended.
Chronic paronychia is treated by avoiding whatever is causing it, a topical antifungal,
and a topical steroid. In those who do not improve following these measures oral antifungals
and steroids may be used or the nail fold may be removed surgically.
References ^ Rigopoulos D, Larios G, Gregoriou S, Alevizos
A. "Acute and chronic paronychia". Am Fam Physician 77: 339–46. PMID 18297959.
^ a b c d Rockwell PG. "Acute and chronic paronychia". Am Fam Physician 63: 1113–6.
PMID 11277548. ^ a
b c James, William D.; Berger, Timothy G.. Andrews' Diseases of the Skin: clinical Dermatology.
Saunders Elsevier. ISBN 0-7216-2921-0. ^ a b c Freedberg, Irwin M., ed.. Fitzpatrick's
Dermatology in General Medicine. McGraw-Hill Publishing Company. ISBN 0071380760.
^ Rigopoulos, Dimitris; Larios, George; Gregoriou, Stamatis; Alevizos, Alevizos. "Acute and Chronic
Paronychia". American Family Physician 77: 339–346. PMID 18297959. Retrieved January
7, 2013. ^ a b c d e f Ritting, AW; O'Malley, MP; Rodner,
CM. "Acute paronychia.". The Journal of hand surgery 37: 1068–70; quiz page 1070. doi:10.1016/j.jhsa.2011.11.021.
PMID 22305431. ^ Rigopoulos, Dimitris; Larios, George; Gregoriou,
Stamatis; Alevizos, Alevizos. "Acute and Chronic Paronychia". American Family Physician 77:
339–346. PMID 18297959. Retrieved January 8, 2013.
^ a b c d Rigopoulos, D; Larios, G; Gregoriou, S; Alevizos, A. "Acute and chronic paronychia.".
American family physician 77: 339–46. PMID 18297959. ^ "Doctor's advice Q: Whitlow". bbc.co.uk.
Retrieved 2008-05-10. ^ Lewis MA. "Herpes simplex virus: an occupational
hazard in dentistry". Int Dent J 54: 103–11. doi:10.2956/indj.2004.54.2.103. PMID 15119801.
^ Karen Allen, MD. "eMedicine - Acrokeratosis Neoplastica".
^ http:emedicine.medscape.com1106062-clinical ^ http:dermatology-s10.cdlib.orgreviewsrashid.html
External links "Paronychia Nail Infection". Dermatologic
Disease Database. American Osteopathic College of Dermatology. Retrieved 2006-07-12.
"What Is The Best Way To Treat Paronychias?, Roundtable discussion in Podiatry Today, Volume
15 - Issue 3, March 2002, pp. 58–60.