Paronychia

Paronychia is an infection of the perionychium (also called eponychium), which is the epidermis bordering the nail.

• M/C bacterial infection of hand

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Aetiology

Acute paronychia:

Infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting for < 6 weeks.

Infection generally starts in the paronychium at the side of the nail, with local redness, swelling, and pain.

• Commonly bacterial:
  • Staphylococcus aureus
  • Streptococcus pyogenes
• Direct or indirect trauma to the cuticle or nail fold
  • Minor events:
    • Dishwashing
    • Splinter or thorn
    • Nail-biting, biting or picking at a hangnail
    • Finger sucking
    • Ingrown nail
    • Manicure procedures

Chronic paronychia

Infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting for > 6 weeks.

Cuticle separates from the nail plate, leaving the region between the proximal nail fold and the nail plate vulnerable to infection

• Commonly fungal:
  • Candida
• Commonly in moist local environments, and is often due to contact dermatitis
  • Dish washing
  • Finger sucking
  • Aggressively trimming the cuticles
  • Frequent contact with chemicals (mild alkalis, acids, etc.)

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Clinical features

• Swelling, erythema, and pain at the base of the fingernail
• Hangnail or floating nail

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Management

Initial management:

• Warm water soak
• Tetanus booster (required)
• Bacterial: Antistaphylococcal penicillin or a first-generation cephalosporin  (Clindamycin or Cephalexin)
• Fungal: Topical antifungal/steroid therapy

Incision & drainage

If pus present

Removal of nail

If floating nail