Paronychia

Last updated
Paronychia
Other namesInfection of skin around the nail [1]
Paronychia.jpg
Specialty Dermatology, emergency medicine
TypesAcute and chronic

Paronychia is an inflammation of the skin around the nail, often due to bacteria or fungi.

Contents

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]

Etymology


The term paronychia is from the Greek : παρωνυχία from para, "around", onyx, "nail" and the noun suffix -ia . [5] [6] [7] [8]

Signs and symptoms

The index and middle fingers are most commonly affected and may present with redness, swelling and pain. Pus or discharge may be present. [2]

Causes

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]

Diagnosis

Types

Paronychia aka "swollen nail" may be divided as occurring suddenly, acute, or gradually, chronic. [14]

Acute

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

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]

  • Candidal paronychia is an inflammation of the nail fold produced by C. albicans. [14] :310
  • Pyogenic paronychia is an inflammation of the folds of skin surrounding the nail caused by bacteria. [14] :254 Generally, acute paronychia is pyogenic, as it is usually caused by a bacterial infection. [4]

Differential

Differential diagnosis of paronychia includes:

Treatment

Incision after paronychia of the thumb, partial removal of the nail Nagelbettentzuendung-inzision.jpg
Incision after paronychia of the thumb, partial removal of the nail

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]

Antibiotics

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]

Epidemiology

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]

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References

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  2. 1 2 3 4 5 6 7 James G. Marks; Jeffrey J. Miller (2013). "21. Nail disorders". Lookingbill and Marks' Principles of Dermatology E-Book (Fifth ed.). Elsevier Saunders. p. 256. ISBN   978-1-4557-2875-6.
  3. Rigopoulos D, Larios G, Gregoriou S, Alevizos A (February 2008). "Acute and chronic paronychia". Am Fam Physician. 77 (3): 339–46. PMID   18297959.
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  5. Harper, Douglas. "paronychia". Online Etymology Dictionary .
  6. παρωνυχία, παρά, ὄνυξ . Liddell, Henry George ; Scott, Robert ; A Greek–English Lexicon at the Perseus Project.
  7. Harper, Douglas. "paronychia". Online Etymology Dictionary .
  8. παρωνυχία, παρά, ὄνυξ . Liddell, Henry George ; Scott, Robert ; A Greek–English Lexicon at the Perseus Project.
  9. "Doctor's advice Q: Whitlow (paronychia)". bbc.co.uk . Retrieved 2008-05-10.
  10. "Bar Rot". The Truth About Bartending. January 27, 2012. Archived from the original on 2013-03-22.
  11. Karen Allen, MD (2005-08-17). "eMedicine – Acrokeratosis Neoplastica". Medscape.
  12. Paronychia~clinical at eMedicine
  13. Serratos BD, Rashid RM (2009). "Nail disease in pemphigus vulgaris". Dermatol. Online J. 15 (7): 2. doi:10.5070/D34X05D6VH. PMID   19903430.
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  15. 1 2 3 Freedberg, Irwin M., ed. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill Publishing Company. ISBN   978-0071380768.
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  17. Rigopoulos, Dimitris; Larios, George; Gregoriou, Stamatis; Alevizos, Alevizos (2008). "Acute and Chronic Paronychia" (PDF). American Family Physician. 77 (3): 339–346. PMID   18297959 . Retrieved January 8, 2013.
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  19. 1 2 3 Ritting, AW; O'Malley, MP; Rodner, CM (May 2012). "Acute paronychia". The Journal of Hand Surgery. 37 (5): 1068–70, quiz page 1070. doi:10.1016/j.jhsa.2011.11.021. PMID   22305431. S2CID   29619616.
  20. Rigopoulos, Dimitris; Larios, George; Gregoriou, Stamatis; Alevizos, Alevizos (1 February 2008). "Acute and Chronic Paronychia". American Family Physician. 77 (3): 339–346. ISSN   0002-838X. PMID   18297959.