Paronychia generally begins with swelling and pain around the sides or base of the nail . Acute paronychia can lead to pus-filled pockets that can be found at the side or base of the fingernails or toenail. Chronic paronychia generally causes a break down in cuticle and may force a separation of the nail from the skin. The nail may become thick, hard and deformed.
Paronychia can be diagnosed with the aid of a simple physical exam. In many cases, special tests are not necessary but it may be important to send a sample of fluid or pus to the laboratory in a bid to identify bacteria or fungus that is responsible for the infection .
To identify the organism causing the condition, routine Gram staining and culture is often used . Tzanck smears can be performed if herpetic whitlow is suspected in any case. On suspicion of osteomyelitis, a plain film radiograph can be obtained. This will help prevent a recurrence of the infection.
A radiograph can also be obtained if the patient has a recent history of finger trauma or if a foreign body is suspected.
Treating paronychia is entirely dependent on the seriousness of the condition. In situations where the symptoms are detected early, paronychia that doesn’t have abscess formation and can be fully treated nonsurgically. However if there is abscess, it can be managed by draining the pus via a small incision .
To treat acute paronychia, the affected finger can be treated by regular warm soaks of 3 to 4 times per day until symptoms are relieved. The warm soaks can be supported with antibiotics like clindamycin, clavulanic acid and amoxicillin.
Treatment of chronic paronychia focuses on protecting the finger from moist areas. With the affected area kept dry, the chances of recovery is higher. This can be supported medically with the application of topical antifungal creams. Miconazole is among the first agents that can be used but oral fluconazole and ketoconazole can also be helpful.
If after the best possible medical management the paronychia is not resolved, surgical management may be required. For acute paronychia, the no-incision procedure is what is often followed. The pus is often drained by lifting the eponychial fold with the aid of a small blunt instrument .
For chronic paronychia, the eponychial marsupialisation is the surgical procedure of choice. The technique simply involves anesthetisation of the affected finger with 1% lidocaine. A crescent-shaped incision is then made around the distal edge of the eponychial fold. All the affected tissues within the boundaries of the crescent-shaped incision are excised with the exception of the germinal matrix. The excised part is packed with plain gauze and changed every 2 to 3 days.
If treated properly and promptly, prognosis is good for paronychia . However, it can also lead to more serious infections such as osteomyelitis and septic tenosynovitis. It may also give rise to a whitlow as a result of its spreading to the pulp space of the finger.
Infection such as this is seen commonly with patients of immunosuppression and in people whose conditions have been mistreated or neglected. Other complications that may arise include nail loss, discoloration, thickening or secondary ridging
The ground for a case of paronychia is set by injury to the area . The injury may arise as a result of picking a hangnail, trimming or pushing back of the cuticle and biting off. The condition is caused by bacteria and fungi. There are various types of fungi that can cause the condition but candida yeast is the most common.
A combination of fungal and bacterial fungal infection is possible.
Paronychia is a common infection around the world. In the United States however, it is responsible for at least 35% of reported hand infection cases . There is also gender based disparity as it is seen three times more in women.
In acute paronychia, the breaking down of barrier opens up a pathway allowing bacteria and other microorganisms to get under the part of the finger or toes that is otherwise impenetrable . This leads to an acute bacterial infection of the soft tissues around the finger nail. In some cases, it can get under the nail plate.
In chronic paronychia, negative changes to the cuticle and proximal nail fold makes it easy for water and other irritants to come in contact with the undersides of the proximal nail fold. The resultant environment provides optimal environment for the growth of yeast. Continued irritation of the area leads to the development of chronic dermatitis.
To prevent acute paronychia, proper care of the nails is important. This means avoiding bites on the nails, injuries to nails and fingertips, keeping the nails trimmed and smooth, avoiding the cutting of nails too short, avoiding the trimming o the cuticle, etc. It is also important to use clean scissors and clippers.
Chronic paronychia can be avoided by keeping the hands dry and free from chemicals. Gloves must be worn when working with water or harsh chemicals and socks should be changed at least every day. Avoid wearing the same shoes two days in row to give them the chance to dry out properly.
Paronychia is the infection of the skin surrounding the toenails and fingernails . It generally affects the skin at the base or around the sides. There are two main types of paronychia, acute paronychia and chronic paronychia. Acute paronychia generally occurs in just one nail while chronic paronychia occurs in more than one nail at once. Chronic paronychia is harder to remedy as it takes longer to clear and may recur in future.
The condition can be treated with a combination hygiene and use of antibiotics in many cases. The outlook is very positive unless complications arise.