• Paronychia

    Definition

    Paronychia is inflammation of the skin that surrounds a fingernail or toenail. It may be acute or chronic and commonly results from infection with either bacteria or fungi.
    Infection Surrounding the Toenail
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    Causes

    Paronychia occurs when a bacteria or fungus enters damaged skin surrounding the nail. The damaged skin can be torn cuticles, cuts, or cracks.

    Risk Factors

    Factors that increase your chance of getting paronychia include:
    • Diabetes
    • Work that requires frequent exposure to chemical solvents or water, including food service, cleaning, dentistry, bartending, hairdressing, and nursing
    • Habitual nail-biting
    • Overly aggressive manicuring

    Symptoms

    Symptoms include:
    • Redness and swelling of the skin around the nail
    • Pus formation near the nail
    • Pain and tenderness to the touch
    • Discoloration or ridging of the nail
    • Absence of the cuticle

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. If there is pus, your doctor may advise that you have it drained. You should not try to drain the pus yourself. Your doctor may send a sample of the pus to the lab for testing.

    Treatment

    Treatments are different for acute and chronic paronychia.
    Acute Paronychia
    A mild case of acute paronychia that causes minor swelling or redness near the nail may be treated by soaking the affected nail in warm water. This treatment can be repeated 2-4 times daily, for about 15 minutes each.
    In most cases, this type of paronychia heals within 5-10 days. If your condition does not improve, your doctor may prescribe oral antibiotic medication. In cases where a build up of pus is suspected, your doctor may also cut the area with a scalpel to drain it.
    Chronic Paronychia
    Since some chronic cases might be caused by fungi, your doctor may give you an antifungal medication. It may be given in a liquid form that you apply directly to the infected area.
    Chronic paronychia may also be caused by a mixed bacterial infection, which can be treated with antibiotics. You may need to take the medication for several weeks. Some dermatologists believe that chronic paronychia is often caused by inflammation rather than by either bacterial or fungal infections. For such non-infectious paronychia, the use of cortisone creams can be helpful.
    Whatever treatment is prescribed, it is important to keep the skin clean and dry. It is also important to avoid getting irritating substances, such as strong cleaners or certain foods, on the area. Surgery may be recommended in some cases of chronic paronychia that do not respond to other treatments.
    Symptoms may subside with treatment. However, permanent damage to the nail or surrounding tissue sometimes result.

    Prevention

    To help prevent paronychia:
    • Keep your hands and feet clean and dry.
    • Wear rubber gloves if your hands are routinely exposed to water or chemicals.
    • Avoid biting your nails.
    • Avoid cutting, pulling, or tearing your cuticles.
    • Avoid artificial nails, vigorous manicures, or treatments that remove the cuticles.
    • If you have diabetes , maintain your blood sugar levels as close to normal as possible.
    • Practice proper hygiene. Do not share bathroom supplies.

    RESOURCES

    American Academy of Dermatology http://www.aad.org

    National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.nih.gov/niams

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Health Canada http://hc-sc.gc.ca

    References

    Rockwell P. Acute and chronic paronychia. Am Fam Physician. 2001 Mar 15;63(6):1113-7.

    Daniel CR III, Daniel MP, Daniel J, Sullivan S, Bell FE. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis . 2004 Jan;73(1):81-5.

    Dwayne C. Common acute hand infections. Am Fam Physician . 2003;68:2167-176.

    Paronychia. KidsHealth from Nemours website. Available at: http://kidshealth.org/parent/infections/skin/paronychia.html. Updated March 2012. Accessed March 25, 2013.

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