Paronychia

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Paronychia
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Paronychia

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For patient information, click Paronychia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Michael Maddaleni, B.S. Luke Rusowicz-Orazem, B.S.

Synonyms and keywords: Felon, Whitlow

Overview

The nail disease paronychia is an often tender bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toenail. It can start suddenly (acute paronychia) or gradually (chronic paronychia). Despite the small area affected these infections can be extremely painful as the skin becomes inflamed, hot, red, and throbs continually. Pus is usually present, along with gradual thickening and browning discoloration of the nail plate.

Classification

Acute paronychia is usually caused by bacteria. This is often treated with antibiotics, sometimes as a cream, other times orally.

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 goes on and on then a fungal infection is often the cause and this needs anti-fungal cream or paint to treat it.

Prosector's paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specimens for dissection.

Runaround paronychia is the name sometimes used to refer to paronychia that is around the entire nail.

Pathophysiology

The cuticle acts as a protective seal, but if it is damaged in any way then pathogens are able to enter the skin and cause infection.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Afatinib, Indinavir, Isotretinoin, Panitumumab
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Excessive immersion of hands in water
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Candida albicans, Eikenella corrodens, Fusobacterium, Herpes simplex, Peptostreptococcus, Porphyromonas spp, Prevotella, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pyogenes, Syphilis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Acrokeratosis paraneoplastica
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Acrokeratosis paraneoplastica
Sexual Herpes simplex, Syphilis
Trauma Trauma
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

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Natural History, Complications and Prognosis

Complications are rare, but may include:

The prognosis for paronychia is good because it usually responds well to treatment. However, fungal infections may last for several months.

Diagnosis

Symptoms

The main symptom is a painful, red, swollen area around the nail, often at the cuticle or at the site of a hangnail or other injury. There may be pus-filled blisters, especially with a bacterial infection. Bacteria causes the condition to occur suddenly. If all or part of the infection is due to a fungus, it tends to occur more slowly.

Nail changes may occur. For example, the nail may look detached, abnormally shaped, or have an unusual color.

Physical Examination

The images below are good examples of how a patient with paronychia would present.

Image shown below is courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Treatment

Pharmacotherapy

Acute Pharmacotherapies

In extreme cases, infections can move under the fingernail and need partial or complete nail removal. Unless there is an extensive cellulitis (inflammation and infection of the soft tissue around the nail), antibiotics are usually not necessary.

Surgery and Device Based Therapy

Indications for Surgery

If a large amount of pus has collected, then it may be necessary to make a small cut in the skin (sometimes under local anaesthetic) to release it.[2]

The doctor will most likely use medicine (such as lidocaine) to numb the entire finger first and then will open the abscess using a surgical knife (scalpel).

Your doctor may or may not take a culture of the drainage to check for a bacterial infection.

Pre-Operative Assessment

Care at home includes warm soaks in a mixture of 50% warm water and 50% liquid antibacterial soap 3-4 times daily for about 15 minutes. This soaking should be done at the first sign of redness around the nail.

Post-Operative Management[3]

After your doctor has drained the paronychia, warm soaks are still recommended. Sometimes packing called a wick is placed in the abscess to allow it to continue to drain when you go home and to keep it from closing up and re-forming the abscess. The packing is usually left in for 24-48 hours. Usually, antibiotics are only prescribed if the infection involves more of the finger than around the nailbed. It is important to follow up with your doctor in 24-48 hours to be sure that the infection is healing properly

Primary Prevention

To prevent paronychia:

  • Care for the nails and the skin around the nails properly.
  • Avoid damaging the nails or fingertips. Because the nails grow slowly, an injury can last for months.
  • Do not bite or pick the nails.
  • Protect the nails from exposure to detergents and chemicals by using protective rubber or plastic gloves, preferably with cotton liners.
  • Bring your own manicure tools to nail salons.

To minimize the risk of damage to the nails:

  • Keep the nails smooth and trim them weekly.
  • Trim the toenails about once a month.
  • Use sharp manicure scissors or clippers for trimming fingernails and toenails, and an emery board for smoothing the edges.
  • Trim nails after bathing, when they are softer.
  • Trim fingernails with a slightly rounded edge. Trim toenails straight across and don't cut them too short.
  • Do not trim cuticles or use cuticle removers. Cuticle removers may damage the skin around the nail. Trimming the cuticle damages the skin at the base of the nail and allows an entry point for fungi (and bacteria), which can lead to infection.

References

  1. 1.0 1.1 "Dermatology Atlas".
  2. Jacobs, J.R. (2006 June-July). "Pathophysiology and Management of Paronychia". collegehealth-e. Text " pp. 10–12" ignored (help); Unknown parameter |Issue= ignored (|issue= suggested) (help); Check date values in: |date= (help)
  3. Directly from WebMD



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