Paronychia

  • Definition

    Paronychia is inflammation or infection of the skin that surrounds a fingernail or toenail.
    Treatment depends on whether the paronychia is acute or chronic.
    Infection Surrounding the Toenail
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  • Causes

    Paronychia is caused by bacteria or fungi that enter damaged skin. Damaged skin can be from torn cuticles, cuts, or cracks.
  • Risk Factors

    Factors that increase your chance of getting paronychia include:
    • Diabetes
    • Work that requires frequent exposure to chemical solvents or water, including food service, cleaning, dentistry, bartending, hairdressing, and nursing
    • Habitual nail-biting
    • Overly aggressive manicuring
  • Symptoms

    Paronychia may cause:
    • Redness and swelling of the skin around the nail
    • Pus formation near the nail
    • Pain and tenderness to the touch
    • Discoloration or ridging of the nail
    • Absence of the cuticle
  • Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. In most cases, paronychia can be seen on examination. If you have an abscess, your doctor may take a sample of the pus to identify the specific cause of the infection.
  • Treatment

    Treatments are different for acute and chronic paronychia.
    Acute Paronychia
    A mild case of acute paronychia is usually caused by bacteria. Minor swelling or redness near the nail may be treated by soaking the affected nail in warm water. This treatment can be repeated 2-4 times daily, for 15 minutes at a time.
    In most cases, this type of paronychia heals within 5-10 days. If your condition does not improve, or is severe, your doctor may prescribe oral antibiotic medication. In cases where a build up of pus is suspected, your doctor may also cut the area with a scalpel to drain it. It is possible that your doctor will need to remove part of the nail.
    Chronic Paronychia
    Since some chronic cases might be caused by fungi, your doctor may give you an antifungal medication. It may be given in a liquid form that you apply directly to the infected area.
    Chronic paronychia may also be caused by a mixed bacterial infection, which can be treated with antibiotics. You may need to take the medication for several weeks. Some dermatologists believe that chronic paronychia is often caused by inflammation rather than by either bacterial or fungal infections. For such non-infectious paronychia, the use of cortisone creams can be helpful.
    Whatever treatment is prescribed, it is important to keep the skin clean and dry. It is also important to avoid getting irritating substances, such as strong cleaners or certain foods, on the area. Surgery may be recommended in some cases of chronic paronychia that do not respond to other treatments.
    Symptoms may subside with treatment. However, permanent damage to the nail or surrounding tissue sometimes results.
  • Prevention

    To help reduce your chance of getting paronychia, take these steps:
    • Keep your hands and feet clean and dry.
    • Wear rubber gloves if your hands are routinely exposed to water or chemicals.
    • Avoid biting your nails.
    • Avoid cutting, pulling, or tearing your cuticles.
    • Avoid artificial nails, vigorous manicures, or treatments that remove the cuticles.
    • If you have diabetes, maintain your blood sugar levels as close to normal as possible.
    • Practice proper hygiene. Do not share bathroom supplies.
  • RESOURCES

    American Academy of Dermatology http://www.aad.org

    National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Health Canada http://hc-sc.gc.ca

    References

    Daniel CR III, Daniel MP, et al. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis. 2004 Jan;73(1):81-5.

    Dwayne C. Common acute hand infections. Am Fam Physician. 2003;68:2167-176.

    Paronychia. KidsHealth from Nemours website. Available at: http://kidshealth.org/parent/infections/skin/paronychia.html. Updated March 2012. Accessed September 19, 2013.

    Rigopoulos D, Larios G, et al. Acute and chronic paronychia. Am Fam Physician. 2001 Mar 15;63(6):1113-7.

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