Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA
Paronychia (Infection of the Nail Fold)
Overview
- Paronychia is an infection involving:
- Nail fold surrounding fingernail or toenail
- One of the most common hand infections
Types
- Acute paronychia
- Chronic paronychia
Key Point
- These two types differ in:
- Cause
- Presentation
- Treatment
Acute Paronychia
Definition
- Acute, rapidly developing bacterial infection of nail fold
- Usually affects:
- Single finger
Causes
- Minor trauma to nail fold:
- Hangnails
- Nail biting
- Aggressive manicure
- Nail picking
- Minor injuries
Pathogenesis
- Break in skin — bacterial entry — infection
Clinical Features
- Redness around nail fold
- Swelling
- Tenderness
- Warmth
- Pus formation (abscess)
Common Organism
- Staphylococcus aureus infection
Treatment
Early Stage (No Abscess)
- Warm water soaks
- Oral antibiotics
Common Antibiotics
- Clindamycin
- Amoxicillin-clavulanic acid
Abscess Present
- Incision and drainage (I&D)
Additional Measures
- Partial/complete nail removal (if needed)
- Continue antibiotics
Chronic Paronychia
Definition
- Long-standing infection of nail fold
- Usually fungal in origin
Common Organism
- Candida albicans infection
Risk Factors
- Diabetes mellitus
- Immunocompromised states
- Certain medications
Occupational Risk
- Frequent exposure to water/chemicals:
- Dishwashers
- Bartenders
- Gardeners
- Housekeepers
- Laundry workers
Clinical Features
- Chronic inflammation of nail fold
- Redness and swelling
- Tenderness
- Multiple fingers involved
- No pus formation
- Recurrent/persistent symptoms
Important Note
- Poor response to antibiotics
Treatment
Conservative Management
- Avoid prolonged water exposure
- Protect hands from irritants
- Topical antifungal therapy
Common Treatment
- Miconazole
Adjunct
- Topical corticosteroids
Surgical Treatment
Indication
- Severe or resistant cases
Procedure
- Marsupialization of nail fold
Key Differences
| Feature | Acute Paronychia | Chronic Paronychia |
|---|---|---|
| Onset | Rapid | Long-standing |
| Cause | Bacterial | Fungal |
| Fingers involved | Single | Multiple |
| Pus | Present | Absent |
| Treatment | Antibiotics + drainage | Antifungal + prevention |
Key Clinical Points
- Acute paronychia:
- Treat early to prevent abscess
- Chronic paronychia:
- Address underlying exposure and fungal cause
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