Paronychia refers to inflammation of the nail fold. It can be acute or chronic.
Acute paronychia develops over a few hours when a nail fold becomes painful, red and swollen. Sometimes yellow pus appears under the cuticle. In some cases acute paronychia is accompanied by fever and painful glands under the arms.
It is usually due to Staphylococcus aureus, a bacterial infection treated with oral antibiotics. Sometimes an abscess forms and has to be lanced. it can also be due to the cold sore virus, herpes simplex, when it is known as herpetic whitlow.
Acute paronychia usually clears completely in a few days, and rarely recurs.
Acute staphylococcal paronychia
Acute staphylococcal paronychia
Acute herpetic paronychia
Paronychia induced by isotretinoin
Paronychia and ingrown toenail in an athlete
Chronic paronychia is a gradual process and much more difficult to get rid of. It may start in one nail fold but often spreads to several others. Each affected nail fold is swollen and lifted off the nail plate. It may be red and tender from time to time, and sometimes a little pus (white, yellow or green) can be expressed from under the cuticle.
The nail plate becomes distorted and ridged as it grows. It may become yellow or green and brittle. After recovery, it takes up to a year for the nails to grow back to normal.
Chronic paronychia may be due to several different micro-organisms and/or a form of dermatitis. Often a mixture of yeasts and bacteria are present, particularly candida species and Gram negative bacilli. The inflammation results in debris which builds up, encouraging more infection.
It mainly occurs in people who have constantly wet hands, such as dairy farmers, fishermen, bar tenders and housewives. It is more likely to occur, and more difficult to clear up, in those with poor circulation, especially during the winter months. It can also be a complication of hand dermatitis.
The following measures may improve paronychia.
- Keep the hands dry and warm.
- Avoid wet work, or use totally waterproof gloves.
- Keep fingernails scrupulously clean.
- Wash thoroughly after dirty work with soap and water, rinse off and dry carefully.
- Don't let the skin dry out.
- Apply a emollient hand cream frequently - dimeticone barrier creams may help.
- Apply antiseptics or antifungal lotions regularly twice daily to the nail fold - suitable preparations include sulfacetamide, thymol, miconazole, ciclopirox.
- Occlusive paints can be useful; flexible collodion can be applied over the nail fold as a barrier to water and germs.
- A course of an oral antifungal agent (itraconazole or fluconazole) may be recommended by a dermatologist.
- Once infection is controlled, a topical steroid cream may be required to settle down the dermatitis.
It often takes months to clear paronychia, and it can recur in predisposed individuals.
On DermNet NZ:
- Introduction to fungal infections
- Laboratory tests for fungal infections
- Treatment of fungal infections
- Dermatologic Manifestations of Paronychia – Medscape Reference
- Paronychia Drainage – Medscape Reference
- Paronychia (Nail Infection) – emedicinehealth
- Paronychia – chronic – British Association of Dermatologists
- Patient information: Paronychia (The Basics) – UpToDate (for subscribers)
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