Paronychia generally begins with swelling and pain around the sides or base of the nail [6]. 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.

If the paronychia is caused by bacteria, it can deteriorate very quickly. If it is caused by fungus, the progression is a lot slower.

• Swelling

  The infection often shows itself as red, painful swelling near where the skin meets the nail. [footfiles.com]

  Soaking reduces swelling and pain and assists in healing. Warm compresses applied to the finger or toe can also reduce pain and swelling. Changes in nail color, ridged or thickened nails, or loss of the nail may occur. [livestrong.com]

  In toes, infection often begins in an ingrown toenail Occasionally the infection can be viral, due to either the herpes simplex virus (HSV), or orf virus Acute paronychia presents as a tender swelling, most commonly of the lateral nail folds, with erythema [pcds.org.uk]

  The patient, who was employed as a dishwasher, had had pain and swelling for more than 6 months. [patientcareonline.com]

  When a felon having redness, swelling and pain in the nail roll, from under which the pus can be released. Treatment of paronychia in the initial stages of conservative: the bath with potassium permanganate, an antiseptic. [minclinic.ru]

• Fever

  When to seek medical advice Call your child’s healthcare provider right away if any of these occur: Fever (see Fever and children, below) Redness or swelling that gets worse Fussiness or crying that can’t be soothed Pain that gets worse Red streaks in [fairview.org]

  This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin B. [ncbi.nlm.nih.gov]

  If you are diabetic, have several affected fingers or toes, or have severe symptoms (pus, fever, severe pain), you must be evaluated by a doctor. In most cases, your doctor can make the diagnosis by examining the affected area. [health.harvard.edu]

  The individual should contact her health care provider if the swelling or pain worsen, pus begins to drain, or she has a fever. [livestrong.com]

• Chronic Infection

  Abstract Acute and chronic infections and inflammation adjacent to the fingernail, or paronychia, are common. [ncbi.nlm.nih.gov]

  Chronic infections have a multifactorial etiology and can lead to nail changes, including thickening, ridging, and discoloration. Large, prospective studies are needed to identify the best treatment regimen for acute and chronic paronychia. [journals.lww.com]

  Chronic paronychia The underlying agent of infection in chronic paronychia is most commonly Candida yeast, but it can also be bacteria. [healthline.com]

• Candidiasis

  Differential Diagnosis Candidiasis Felon finger Herpetic whitlow Glomus tumor Malignant melanoma [handsurgeryresource.com]

  In 8 patients with proven and severe candidiasis of the nails, oral fluconazole 100 mg was added for 20 days. All patients with bacterial perionyxis took clarithromycin 500 mg twice daily for six days. Patients were then followed for 8 weeks. [ncbi.nlm.nih.gov]

  The Prevalence of vaginal candidiasis was significantly affected by trimester of pregnancy (P= 0.0004). Pregnant women in the third trimester had the highest risk of acquiring vulvovaginal candidiasis. [researchgate.net]

  Type 2 Excludes hordeolum ( H00.0 ) infective dermatitis ( L30.3 ) local infections of skin classified in Chapter 1 lupus panniculitis ( L93.2 ) panniculitis NOS ( M79.3 ) panniculitis of neck and back ( M54.0- ) Perlèche NOS ( K13.0 ) Perlèche due to candidiasis [icd10data.com]

  When candidiasis is suspected, the area should be kept dry and treated with local applications of nystatin or a topical antifungal medication combined with a topical steroid (e.g., betamethasone 0.05% + clotrimazole 1% [Lotrisone] cream). [aneskey.com]

• Nail Abnormality

  References https://medlineplus.gov/ency/article/001444.htm http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884921/ http://www.nhs.uk/conditions/nail-abnormalities/Pages/Introduction.aspx#Beaus Further Reading All Paronychia Content Paronychia Types and Causes [news-medical.net]

  […] occur and may be responsible for symptomatic impairment and resistance to treatment.2 Paronychia can be extremely painful and mimics an ingrown toenail in severe cases where pyogenic granuloma of the nail fold develops.1-3 Incidence: Nail abnormalities [oncologypro.esmo.org]

  Evaluation of nail abnormalities. Am Fam Physician. 2012;85(8):779–787. 29. Tosti A, Piraccini BM, Ghetti E, Colombo MD. [aafp.org]

• Vascular Disease

  In patients with diabetes and those with peripheral vascular disease, toe paronychia can lead to more extensive infection and threaten the limb. [merckmanuals.com]

  In patients with diabetes and others with peripheral vascular disease, toe paronychia should be monitored for signs of cellulitis Cellulitis Cellulitis is acute bacterial infection of the skin and subcutaneous tissue most often caused by streptococci [msdmanuals.com]

  Other management Patients with diabetes and vascular disease with toenail paronychia infections should be examined for signs of cellulitis. Surgical excision of the proximal nail fold may be necessary. [dermnetnz.org]

• Foot Pain

  My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" [foot-pain-explained.com]

• Dermatitis

  Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. [ncbi.nlm.nih.gov]

  Repetitive micro trauma and exposure to water, irritants, and allergens, resulting in a dermatitis with subsequent colonization by yeasts, and secondary bacterial infection, are causative factors in chronic paronychia, one of the commonest nail disorders [en.tzermias.gr]

  Pemphigus Vulgaris, Psoriasis, Eczematous Dermatitis, Irritant Contact Dermatitis ) Occupational Trauma (e.g. bartenders, dish washers) V. [fpnotebook.com]

• Skin Disease

  Resources American Academy of Dermatology https://www.aad.org National Institute of Arthritis and Musculoskeletal and Skin Diseases https://www.niams.nih.gov Canadian Resources Canadian Dermatology Association https://dermatology.ca Health Canada https [winchesterhospital.org]

  —The tumors ulceration Unna urticaria usually vary vesicles vessels xanthoma Bibliografiske oplysninger Titel Diseases of the Skin Diseases of the Skin, Richard Lightburn Sutton Forfatter Richard Lightburn Sutton Udgiver C.V. [books.google.dk]

  Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 182. [medlineplus.gov]

• Nail Deformity

  nail deformity may result; - curretting may result in full thickness loss of matrix in that area which result in very severe nail bed deformity if left untreated; - salvage treatment consists of removing a split thickness graft fromm adjacent normal [wheelessonline.com]

  Paronychia symptoms include: swelling, tenderness, and redness around the nail puss-filled abscesses hardening of the nail deformation or damage to the nail the nail separating from the nailbed Share on Pinterest Biting the nails or the skin around the [medicalnewstoday.com]

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 [7].

To identify the organism causing the condition, routine Gram staining and culture is often used [8]. 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.

• Candida

  Hypersensitivity to Candida is more likely to be the etiology, rather than the infection itself. [ncbi.nlm.nih.gov]

  Prick test with Candida allergen was positive in 47.6% patients (31 out of 65 patients tested). [mdmag.com]

  The presence of Candida was not linked to disease activity; mycological examination before treatment revealed the presence of Candida in the proximal nail fold of only 18 of 45 patients. [mdedge.com]

• Staphylococcus Aureus

  This is a case report will present the rare occurrence of a paronychia in a neonate caused by methicillin-resistant Staphylococcus aureus. [ncbi.nlm.nih.gov]

  This chapter is set out as follows: Clinical findings Images Investigations Management Clinical findings Acute paronychia Mainly affects children and adolescents The causative organisms are usually Staphylococcus aureus or streptococci, and, less commonly [pcds.org.uk]

  Links: Staphylococcus aureus clinical features treatment [gpnotebook.com]

  Causes Life Threatening Causes Acrokeratosis paraneoplastica Syphilis Common Causes Candida albicans Excessive immersion of hands in water Pseudomonas aeruginosa Staphylococcus aureus Streptococcus pyogenes Trauma Causes by Organ System Cardiovascular [wikidoc.org]

• Pseudomonas

  Ciprofloxacin ) Pseudomonas coverage (green discharge) Ciprofloxacin XIV. [fpnotebook.com]

  Causes Life Threatening Causes Acrokeratosis paraneoplastica Syphilis Common Causes Candida albicans Excessive immersion of hands in water Pseudomonas aeruginosa Staphylococcus aureus Streptococcus pyogenes Trauma Causes by Organ System Cardiovascular [wikidoc.org]

  Bacteria are the most common cause of the infection, predominately Staphylococcus aureus but also certain strains of the Streptococcus and Pseudomonas bacteria. [verywellhealth.com]

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 [9].

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 [10].

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 [5]. 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 [2]. 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.

Fungal paronychia can occur in people who have a fungal nail infection and diabetes. It may also be seen in people guilty of leaving their hands in water for an extended period of time.

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 [3]. 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 [4]. 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.

Due to the nearness of the underlying matrix, secondary plate abnormalities may develop.

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 [1]. 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.

Paronychia is a condition where the corner or side of the nails grow into a soft flesh. This leads to pain, redness, swelling and in many cases, an infection. It can affect any finger.

The condition can be treated with a combination hygiene and use of antibiotics in many cases. The outlook is very positive unless complications arise.

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2. Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. Feb 1 2008;77(3):339-46.
3. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. Mar 15 2001;63(6):1113-6.
4. Roberts JR, Hedges JR. Incision and drainage. In: 4th ed. Clinical Procedures in Emergency Medicine. Philadelphia, Pa: WB Saunders Company; 2004:738-41.
5. Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol. Jul 2002;47(1):73-6. 
6. Rich P. Nail disorders. Diagnosis and treatment of infectious, inflammatory, and neoplastic nail conditions. Med Clin North Am. 1998;82:1171–83,vii.
7. Habif TP. Clinical dermatology: a color guide to diagnosis and therapy. 3d ed. St. Louis: Mosby, 1996.
8. Hochman LG. Paronychia: more than just an abscess. Int J Dermatol. 1995;34:385–6.
9. Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. 1999;17:581–2.
10. Brook I. Aerobic and anaerobic microbiology of paronychia. Ann Emerg Med. 1990;19:994–6.