| Paronychia | |
|---|---|
| Classification and external resources | |
| ICD-10 | L03.0 |
| ICD-9 | 681.02, 681.11 |
| DiseasesDB | 9663 |
| MedlinePlus | 001444 |
| eMedicine | derm/798 |
| MeSH | D010304 |
The nail disease paronychia (/ˌpærəˈnɪkiə/, Greek: παρονυχία), commonly misidentified as a synonym for whitlow or felon, is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail. The infection can start suddenly (acute paronychia) or gradually (chronic paronychia).[1][2]
Contents |
Paronychia may be divided as follows:[3]
Alternatively, paronychia may be divided as follows:[4]
Dr. Rob Hicks writes on the BBC website:
The cuticle acts as a protective seal but if it is damaged in any way bacteria can enter the skin and cause infection. These infections can be extremely painful as the skin becomes inflamed, hot, red and throbs continually.[5]
Pus is usually present, along with gradual thickening and browning discoloration of the nail plate.
Hicks continues:
If a large amount of pus has collected, then it may be necessary to see your doctor who will lance open infection in the skin to release it.[5][6]
Acute paronychia is usually caused by bacteria. Claims have also been made that the popular acne medication, isotretinoin, has caused paronychia to develop in patients. Paronychia is often treated with antibiotics, either topical or oral. 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 is continuous, the cause is often fungal and needs antifungal cream or paint to be treated.[5]
Hicks writes further about the causes:
Whitlows are common, especially for people who have to repeatedly wash their hands. Excess water weakens the seal, while soaps and detergents remove the protective skin oils leaving the skin dry and more liable to split. Most often, trauma to the cuticle allows infection in. Biting or picking at the cuticle, damage through work and overenthusiastic manicuring are the usual culprits. If someone has a cold sore and puts their finger in their mouth then a herpes infection whitlow may appear.[5]
Individuals who work with their hands in water, such as health care workers and food processors, are prone to the fungal type of infection.
Herpes whitlows are frequently found among dentists and dental hygienists.[7] 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. Paronychia around the entire nail is sometimes referred to as runaround paronychia.
Painful paronychia in association with a scaly, erythematous, keratotic rash (papules and plaques) of the ears, nose, fingers, and toes, may be indicative of acrokeratosis paraneoplastica, which is associated with squamous cell carcinoma of the larynx.[8]
Paronychia must also be thought of as a potential drug induced process and this must be ruled out. Furthermore, it may be representative of systemic disease such as pemphigus.[9]
Warm soaks can be used 3 or 4 times a day for acute paronychia to promote drainage and relieve some of the pain. Most cases of acute paronychia should be treated with antibiotics such as cephalexin or dicloxacillin. Topical antibiotics or anti-bacterial ointments do not effectively treat paronychia. If there is pus or an abscess involved, the infection may need to be incised and drained. Rarely, a portion of the nail may need to be removed.
Chronic paronychia is treated with topical antifungal medication such as ketoconazole cream. A mild topical steroid like hydrocortisone may be added to the antifungal medication to help reduce inflammation. Steroids should never be used alone on a chronic paronychia.[10]
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