Paronychia

Key Points
Skin infection and/or inflammation affecting the folds of finger or toenails
Condition may be chronic or acute
Caused by infection with various microorganisms
Acute paronychia consists of swelling, redness and pain in the affected area, while chronic paronychia initially consists of swelling in folds and nails lifting from the nail bed, which leads to disfigurement of nails

Paronychia is a skin infection and/or inflammation which affects the folds of the finger or toenails. The condition may present as chronic or acute. Acute paronychia consists of swelling, redness and pain in the affected area, which may be accompanied by a buildup of pus underneath the cuticle, fever, and gland pain under the arms. This form of the condition typically resolves entirely within several days, and has a very low chance of recurrence. Chronic paronychia initially presents as swelling in the folds of the nails, and the nails themselves lifting from the nail bed, which may be accompanied by tenderness and redness in the affected area, as well as pus buildup underneath the cuticle. This is followed by disfigurement and ridging of nails, in addition to nails becoming discolored (green or yellow) and brittle.

Paronychia is caused by infection with various microorganisms. Acute paronychia is typically due to bacterial infection, while the chronic form of the disorder often results from infection with a variety of organisms, often yeasts and bacteria together. Acute paronychia may occur in anyone. Chronic paronychia is more likely to develop in those persons whose hands are constantly exposed to water. Affected persons with poor circulation may also be more likely to develop the disorder, and will be more difficult to treat. chronic paronychia may also develop in association with eczema.

Differential Diagnosis (Other conditions with similar appearance)
Cutaneous candidiasis
Herpetic whitlow
Contact dermatitis
Nail cosmetics
Dyshidrotic eczema
Onychomycosis
Psoriasis

Diagnosis

Key Points
Diagnosis based on appearance of the affected area
Bacterial culture may be useful to evaluate for secondary infection

Treatment
Avoid excessive hand washing
Eliminate yeast or bacterial colonization or infection
*Liberal use of bland emollients, especially those in an ointment base
OTC Options: Emollients, topical antiseptics and antifungals

Primary goal of treatment is to eliminate the underlying cause, which is usually excessive soap and water exposure to the hands. Rewetting throughout the day actually dries the skin tremendously, allowing inflammation to occur. Liberal use of a bland, ointment based emollient such as white petrolatum is helpful to rehydrate the skin. Elimination of secondary bacterial or yeast infection is important as well. Physicians may also prescribe topical anti-inflammatory medications as well.