Paronychia
Paronychia (whitlow) is an inflammation of the folds of tissue surrounding the nail of a toe or finger.
It can be acute (< 6 weeks) or chronic (persisting > 6 weeks).
The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold. This enables pathogens (bacteria) to inoculate the nail, resulting in infection.
Such trauma may be relatively minor, resulting from ordinary events, such as dishwashing, an injury from a splinter or thorn, onychophagia (nail biting), biting or picking at a hangnail, finger sucking, an ingrown nail, manicure procedures (trimming or pushing back the cuticles), artificial nail application, or other nail manipulation.
Treatment options for acute paronychia include warm compresses; topical antibiotics, with or without corticosteroids; oral antibiotics; or surgical incision and drainage for more severe cases.
Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens.
This disorder can be the result of numerous conditions, such as dish washing, finger sucking, aggressively trimming the cuticles, and frequent contact with chemicals (e.g., mild alkalis, acids).
Chronic paronychia has been reported in laundry workers, house and office cleaners, food handlers, cooks, dishwashers, bartenders, chefs, fishmongers, confectioners, nurses, and swimmers. In such cases, colonization with Candida albicans or bacteria may occur in the lesion.
Avoid exposure to contact irritants; treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid. Application of emollient lotions may be beneficial. Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia. In recalcitrant chronic paronychia, excision of the proximal nail fold is an option.
It can be acute (< 6 weeks) or chronic (persisting > 6 weeks).
The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold. This enables pathogens (bacteria) to inoculate the nail, resulting in infection.
Such trauma may be relatively minor, resulting from ordinary events, such as dishwashing, an injury from a splinter or thorn, onychophagia (nail biting), biting or picking at a hangnail, finger sucking, an ingrown nail, manicure procedures (trimming or pushing back the cuticles), artificial nail application, or other nail manipulation.
Treatment options for acute paronychia include warm compresses; topical antibiotics, with or without corticosteroids; oral antibiotics; or surgical incision and drainage for more severe cases.
Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens.
This disorder can be the result of numerous conditions, such as dish washing, finger sucking, aggressively trimming the cuticles, and frequent contact with chemicals (e.g., mild alkalis, acids).
Chronic paronychia has been reported in laundry workers, house and office cleaners, food handlers, cooks, dishwashers, bartenders, chefs, fishmongers, confectioners, nurses, and swimmers. In such cases, colonization with Candida albicans or bacteria may occur in the lesion.
Avoid exposure to contact irritants; treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid. Application of emollient lotions may be beneficial. Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia. In recalcitrant chronic paronychia, excision of the proximal nail fold is an option.
Acute paronychia
Rapid onset of erythema, edema, and discomfort or tenderness of the proximal and lateral nail folds. May initially present with only superficial infection and accumulation of purulent material under the nail fold, as indicated by drainage of pus when the nail fold is compressed. An untreated infection may evolve into a subungual abscess, with pain and inflammation of the nail matrix. Pus formation can proximally separate the nail from its underlying attachment, causing elevation of the nail plate. Recurrent acute paronychia may evolve into chronic paronychia. |
Chronic paronychia
Presentations are similar to those of acute paronychia: erythema, tenderness, and swelling, with retraction of the proximal nail fold and absence of the adjacent cuticle. Pus may form below the nail fold. One or several fingernails are usually affected. The nail plate becomes thickened and discolored, with pronounced transverse ridges such as Beau's lines (resulting from inflammation of the nail matrix), and nail loss. Chronic paronychia generally has been present for at least six weeks at the time of diagnosis. |