Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Paronychia

1. Basic Concept

Paronychia is an infection or inflammation of the nail fold.

It can be classified into:

1. Acute paronychia
2. Chronic paronychia

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2. Acute Paronychia

Definition

Acute paronychia is an acute infection of the nail fold.

It is one of the common hand infections and usually affects a single digit.

Clinical Features

The nail fold may be:

• Tender
• Red
• Swollen
• Fluctuant
• Associated with pus when an abscess develops

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3. Causes

Acute paronychia commonly follows trauma to the nail fold, including:

• Hangnail
• Nail biting
• Manicuring
• Other minor trauma

Common Organism

Staphylococcus aureus is the most common organism mentioned.

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4. Treatment of Acute Paronychia

Early Infection

If there is no established abscess:

• Antibiotics may be used when indicated.
• The lecture mentions clindamycin and amoxicillin-clavulanate (Augmentin).

Abscess

If an abscess has developed:

Incision and drainage

may be required, with:

• Partial or total nail removal when necessary
• Appropriate antibiotics

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5. Chronic Paronychia

Chronic paronychia differs significantly from acute paronychia.

It is described in the lecture as a fungal infection/inflammation of the nail fold, with:

Candida albicans being the common organism mentioned.

Clinical Features

• Usually affects multiple digits
• Chronic or recurrent course
• Nail fold is:
  • Swollen
  • Inflamed
  • Red
  • Tender
• No abscess

Unlike acute paronychia, chronic paronychia does not respond to antibiotics.

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6. Risk Factors

Chronic paronychia is associated with:

• Diabetes
• Repeated exposure to water
• Exposure to chemical irritants
• Occupations involving frequent wet work

Examples mentioned include:

• Dishwashers
• Bartenders
• Gardeners
• Housekeepers
• Laundry workers

The lecture also mentions association with certain medications and HIV-positive patients.

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7. Treatment of Chronic Paronychia

First-line Measures

• Avoid water exposure
• Reduce exposure to chemical irritants
• Use topical antifungal agents

The lecture mentions miconazole.

Additional Treatment

• Topical corticosteroids may be used.

Resistant Cases

Surgery is considered a last resort.

A procedure such as marsupialization may be performed in severe, resistant cases.

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Acute vs Chronic Paronychia

Feature	Acute	Chronic
Main process	Acute infection	Chronic fungal/inflammatory process
Common organism	Staphylococcus aureus	Candida albicans
Digits	Usually single	Often multiple
Abscess	May be present	Usually absent
Course	Acute	Recurrent/chronic
Antibiotics	May be used	Not effective
Main treatment	Drain abscess when present	Avoid water, topical antifungal ± steroid
Surgery	I&D when abscess present	Last resort, marsupialization

Exam Pearls

• Acute paronychia = painful, red, swollen nail fold, often single digit
• Staphylococcus aureus is the common organism mentioned
• Abscess formation requires incision and drainage
• Chronic paronychia = multiple digits, recurrent, no abscess
• Chronic paronychia is associated with water and chemical exposure
• Candida albicans is the organism mentioned
• Chronic paronychia does not respond to antibiotics
• Treatment includes avoidance of water + topical antifungal ± topical steroid
• Marsupialization is a last-resort treatment for resistant cases.