Paronychia | |
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Other names | Infection of skin around the nail [1] |
Specialty | Dermatology, emergency medicine |
Types | Acute and chronic |
Paronychia is an inflammation of the skin around the nail, often due to bacteria or fungi.
Its sudden (acute) occurrence is usually due to the bacterium Staphylococcus aureus . Gradual (chronic) occurrences are typically caused by fungi, commonly Candida albicans . [2] [3] [4]
Risk factors for paronychia include frequent hand washing and trauma to the cuticle, such as from chronic nail biting or hangnails. [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 with herpetic whitlow or felon, which are distinct conditions. [2]
The term paronychia is from the Greek : παρωνυχία from para, "around", onyx, "nail" and the noun suffix -ia . [5] [6] [7] [8]
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 with antibiotics, either topical (applied to the skin) or oral (taken by mouth), or both. 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. [9]
Risk factors include repeatedly washing hands and trauma to the cuticle such as may occur from repeated nail biting [2] or hangnails. In the context of bartending, it is known as "bar rot". [10]
Painful paronychia in association with a scaly, erythematous, keratotic rash (papules and plaques) of the ears, nose, fingers, and toes may be indicative of acrokeratosis paraneoplastica, which is associated with squamous-cell carcinoma of the larynx. [11]
Paronychia can occur with diabetes, drug-induced immunosuppression, [12] or systemic diseases such as pemphigus. [13]
Paronychia aka "swollen nail" may be divided as occurring suddenly, acute, or gradually, chronic. [14]
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 the paronychium at the side of the nail, with local redness, swelling, and pain. [15] : 660 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. [16] : 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 a nail disease prevalent in individuals whose hands or feet are subject to moist local environments, and is often due to contact dermatitis. [15] : 660 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. [17] : 343 It can be the result of dish washing, finger sucking, aggressively trimming the cuticles, or frequent contact with chemicals (mild alkalis, acids, etc.).
Alternatively, paronychia may be divided as follows: [15]
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. [19]
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. [20]
No strong evidence has been found to recommend topical vs. oral antibiotics, and this may be physician-dependent based on experience. Antibiotics used should have S. aureus coverage. Topical antibiotics used may be a triple 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. [18] Antibiotics such as clindamycin or cephalexin are also often used, the first being more effective in areas where MRSA is common. [19] If signs of an abscess (the presence of pus) are seen, drainage is recommended. [19]
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. [18]
Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head.
A nail disease or onychosis is a disease or deformity of the nail. Although the nail is a structure produced by the skin and is a skin appendage, nail diseases have a distinct classification as they have their own signs and symptoms which may relate to other medical conditions. Some nail conditions that show signs of infection or inflammation may require medical assistance.
Oral candidiasis (Acute pseudomembranous candidiasis), which is also known as oral thrush, among other names, is candidiasis that occurs in the mouth. That is, oral candidiasis is a mycosis (yeast/fungal infection) of Candida species on the mucous membranes of the mouth.
Athlete's foot, known medically as tinea pedis, is a common skin infection of the feet caused by a fungus. Signs and symptoms often include itching, scaling, cracking and redness. In rare cases the skin may blister. Athlete's foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea.
Terbinafine is an antifungal medication used to treat pityriasis versicolor, fungal nail infections, and ringworm including jock itch and athlete's foot. It is either taken by mouth or applied to the skin as a cream or ointment. The cream and ointment should not be used for fungal nail infections.
Dermatophyte is a common label for a group of fungus of Arthrodermataceae that commonly causes skin disease in animals and humans. Traditionally, these anamorphic mold genera are: Microsporum, Epidermophyton and Trichophyton. There are about 40 species in these three genera. Species capable of reproducing sexually belong in the teleomorphic genus Arthroderma, of the Ascomycota. As of 2019 a total of nine genera are identified and new phylogenetic taxonomy has been proposed.
Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Fingernails may be affected, but it is more common for toenails. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.
Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface of the tongue, leaving a smooth and erythematous (reddened) surface,. In a wider sense, glossitis can mean inflammation of the tongue generally. Glossitis is often caused by nutritional deficiencies and may be painless or cause discomfort. Glossitis usually responds well to treatment if the cause is identified and corrected. Tongue soreness caused by glossitis is differentiated from burning mouth syndrome, where there is no identifiable change in the appearance of the tongue, and there are no identifiable causes.
A herpetic whitlow is a herpes lesion (whitlow), typically on a finger or thumb, caused by the herpes simplex virus (HSV). Occasionally infection occurs on the toes or on the nail cuticle. Herpes whitlow can be caused by infection by HSV-1 or HSV-2. HSV-1 whitlow is often contracted by health care workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions. It is also often observed in thumb-sucking children with primary HSV-1 oral infection (autoinoculation) prior to seroconversion, and in adults aged 20 to 30 following contact with HSV-2-infected genitals.
A whitlow or felon is an infection of the tip of the finger. Herpetic whitlow and melanotic whitlow are subtypes that are not synonymous with the term felon. A felon is an "extremely painful abscess on the palmar aspect of the fingertip". Whitlow usually refers to herpetic whitlow, though it can also refer to melanotic whitlow, which somewhat resembles acral lentiginous melanoma. The terms whitlow and felon are also sometimes misapplied to paronychia, which is an infection of the tissue at the side or base of the nail. Felon presents with a throbbing pain, clinically.
Onycholysis is a common medical condition characterized by the painless detachment of the nail from the nail bed, usually starting at the tip and/or sides. On the hands, it occurs particularly on the ring finger but can occur on any of the fingernails. It may also happen to toenails.
A hangnail is a small, torn piece of skin or nail next to a fingernail or toenail. Hangnails are typically caused by having dry skin, trauma to the fingers, or ingrown nails.
Kerion or kerion celsi is an acute inflammatory process which is the result of the host's response to a fungal ringworm infection of the hair follicles of the scalp that can be accompanied by secondary bacterial infection(s). It usually appears as raised, spongy lesions, and typically occurs in children. This honeycomb is a painful inflammatory reaction with deep suppurative lesions on the scalp. Follicles may be seen discharging pus. There may be sinus formation and rarely mycetoma-like grains are produced. It is usually caused by dermatophytes such as Trichophyton verrucosum, T. mentagrophytes, and Microsporum canis. Treatment with oral griseofulvin common.
Trichophyton rubrum is a dermatophytic fungus in the phylum Ascomycota. It is an exclusively clonal, anthropophilic saprotroph that colonizes the upper layers of dead skin, and is the most common cause of athlete's foot, fungal infection of nail, jock itch, and ringworm worldwide. Trichophyton rubrum was first described by Malmsten in 1845 and is currently considered to be a complex of species that comprises multiple, geographically patterned morphotypes, several of which have been formally described as distinct taxa, including T. raubitschekii, T. gourvilii, T. megninii and T. soudanense.
Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock itch. It can be taken by mouth or applied as a cream to the skin or in the vagina.
Green nail syndrome is an infection that can develop in individuals whose hands are frequently submerged in water resulting in discolouration of the nails from shades of green to black. It may also occur as transverse green stripes that are ascribed to intermittent episodes of infection. It is usually caused by the bacteria Pseudomonas aeruginosa and is linked to hands being constantly moist or exposed to chemicals, or in individuals who have damaged or traumatised nails. There are several activities and nail injuries or conditions that are linked to higher risk of contracting the condition.
Psoriatic onychodystrophy or psoriatic nails is a nail disease. It is common in those with psoriasis, with reported incidences varying from 10% to 78%. Elderly patients and those with psoriatic arthritis are more likely to have psoriatic nails.
A cold sore is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.
Streptococcal intertrigo is a skin condition that is secondary to a streptococcal bacterial infection. It is often seen in infants and young children and can be characterized by a fiery-red color of the skin, foul odor with an absence of satellite lesions, and skin softening in the neck, armpits or folds of the groin. Newborn children and infants commonly develop intertrigo because of physical features such as deep skin folds, short neck, and flexed posture. Prompt diagnosis by a medical professional and treatment with topical and/or oral antibiotics can effectively relieve symptoms.
Topical antifungaldrugs are used to treat fungal infections on the skin, scalp, nails, vagina or inside the mouth. These medications come as creams, gels, lotions, ointments, powders, shampoos, tinctures and sprays. Most antifungal drugs induce fungal cell death by destroying the cell wall of the fungus. These drugs inhibit the production of ergosterol, which is a fundamental component of the fungal cell membrane and wall.