| Paronychia | |
|---|---|
| Other names | Infection of skin around the nail[1] |
 | |
| Specialty | Dermatology,emergency medicine |
| Types | Acute and chronic |
Paronychia is aninflammation of theskin around the nail, often due to bacteria or fungi.
Its sudden (acute) occurrence is usually due to the bacteriumStaphylococcus aureus. Gradual (chronic) occurrences are typically caused by fungi, commonlyCandida albicans.[2][3][4]
Risk factors for paronychia include frequent hand washing and trauma to the cuticle, such as from chronicnail biting orhangnails.[2]
Treatment typically involves antibiotics for bacterial infections and antifungals for fungal infections. If there is pus formation,incision and drainage may be necessary.[2]
Paronychia is commonly mistakenly used interchangeably withherpetic whitlow orfelon, which are distinct conditions.[2]
The term paronychia is from theGreek:παρωνυχία frompara, "around",onyx, "nail" and the noun suffix-ia.[5][6]
The index and middle fingers are most commonly affected and may present with redness, swelling and pain. Pus or discharge may be present.[2]
Acute paronychia is usually caused by bacteria. It is often treated withantibiotics, either topical (applied to the skin) or oral (taken by mouth), or both. Chronic paronychia is most often caused by ayeast infection of the soft tissues around the nail but can also be traced to abacterial infection. If the infection is continuous, the cause is oftenfungal and needsantifungal cream or paint to be treated.[7]
Risk factors include repeatedly washing hands and trauma to the cuticle such as may occur from repeatednail biting[2] or hangnails. In the context of bartending, it is known as "bar rot".[8]
Painful paronychia in association with a scaly,erythematous, keratotic rash (papules and plaques) of the ears, nose, fingers, and toes may be indicative ofacrokeratosis paraneoplastica, which is associated withsquamous-cellcarcinoma of thelarynx.[9]
Paronychia can occur withdiabetes, drug-inducedimmunosuppression,[10] or systemic diseases such aspemphigus.[11]
Paronychia aka "swollen nail" may be divided as occurring suddenly, acute, or gradually, chronic.[12]
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.[4] The infection generally starts in theparonychium at the side of the nail, with local redness, swelling, and pain.[13]: 660 Acute paronychia is usually caused by direct or indirect trauma to thecuticle 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 ahangnail, finger sucking, aningrown nail, ormanicure procedures.[14]: 339
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.[4] It is anail disease prevalent in individuals whose hands or feet are subject to moist local environments, and is often due tocontact dermatitis.[13]: 660 In chronic paronychia, the cuticle separates from the nail plate, leaving the region between the proximal nail fold and thenail plate vulnerable to infection.[15]: 343 It can be the result of dish washing, finger sucking, aggressively trimming thecuticles, or frequent contact with chemicals (mildalkalis,acids, etc.).
Alternatively, paronychia may be divided as follows:[13]
Differential diagnosis of paronychia includes:
When no pus is present, warm soaks for acute paronychia are reasonable, though evidence to support its use is lacking.[17]
Chronic paronychia is treated by avoiding whatever is causing it, atopical antifungal, and atopical 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.[18]
No strong evidence has been found to recommend topical vs. oral antibiotics, and this may be physician-dependent based on experience. Antibiotics used should haveS. aureus coverage. Topical antibiotics used may be atriple antibiotic ointment, bacitracin, or mupirocin. In patients failing topical treatment or more severe cases, oral antibiotics are an option; dicloxacillin or cephalexin can be used. Indications for antibiotics with anaerobic coverage include patients where a concern exists for oral inoculation; this would require the addition of clindamycin or amoxicillin-clavulanate.[16]Antibiotics such asclindamycin orcephalexin are also often used, the first being more effective in areas whereMRSA is common.[17] If signs of anabscess (the presence of pus) are seen, drainage is recommended.[17]
Paronychia is more common in women than in men, by a ratio of three to one. Usually, they affect manual-labor workers or people in occupations that require them to have their hands or feet submerged in water for prolonged periods (e.g., dishwashers). Middle-aged females are at the highest risk of infection.[16]
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