Paronychia
Encyclopedia
The nail disease
paronychia (ˌpærəˈnɪkiə), 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).
Alternatively, paronychia may be divided as follows:
:
Pus
is usually present, along with gradual thickening and browning discoloration of the nail plate.
Hicks continues:
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.
Hicks writes further about the causes:
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. Prosector's paronychia is a primary inoculation of tuberculosis
of the skin and nails, named after its association with prosector
s, 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
.
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.
. 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.
Nail disease
Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms which may relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance...
paronychia (ˌpærəˈnɪkiə), commonly misidentified as a synonym for whitlow
Whitlow
A whitlow or felon is an infection of the tip of the finger. The terms are also sometimes misapplied to paronychia, which is an infection of the tissue at the side or base of the nail....
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).
Types
Paronychia may be divided as follows:- Acute paronychiaAcute paronychiaAcute paronychia may follow any break in the skin, characterized by an infection that starts in the paronychium at the side of the nail, with local redness, swelling, and pain....
- Chronic paronychiaChronic paronychiaChronic paronychia is a nail disorder prevalent in individuals whose hands or feet are subject to moist local environments and is often due to contact dermatitis....
Alternatively, paronychia may be divided as follows:
- Candidal paronychiaCandidal paronychiaCandidal paronychia is an inflammation of the nail fold produced by Candida albicans....
- Pyogenic paronychiaPyogenic paronychiaPyogenic paronychia is an inflammation of the folds of skin surrounding the nail caused by bacteria.Generally acute paronychia is a pyogenic paronychia as it is usually caused by a bacterial infection....
Description
Dr. Rob Hicks writes on the BBC websiteBbc.co.uk
BBC Online is the brand name and home for the BBC's UK online service. It is a large network of websites including such high profile sites as BBC News and Sport, the on-demand video and radio services co-branded BBC iPlayer, the pre-school site Cbeebies, and learning services such as Bitesize...
:
The cuticleCuticleA cuticle , or cuticula, is a term used for any of a variety of tough but flexible, non-mineral outer coverings of an organism, or parts of an organism, that provide protection. Various types of "cuticles" are non-homologous; differing in their origin, structure, function, and chemical composition...
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.
Pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...
is usually present, along with gradual thickening and browning discoloration of the nail plate.
Hicks continues:
If a large amount of pusPusPus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...
has collected, then it may be necessary to see your doctor who will lance open infection in the skin to releaseIncision and drainageIncision and drainage and clinical lancing are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus...
it.
Acute paronychia is usually caused by bacteria. Claims have also been made that the popular acne medication, isotretinoin
Isotretinoin
Isotretinoin, INN, is a medication used mostly for cystic acne. It was first developed for brain, pancreatic and other cancers. It is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis. Its effects are systemic and nonselective...
, 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.
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 manicuringManicureA manicure is a cosmetic beauty treatment for the fingernails and hands performed at home or in a nail salon. A manicure treatment is not only a treatment for the natural nails but also for the hands. A manicure consists of filing, shaping of the free edge, treatments, massage of the hand and the...
are the usual culprits.
If someone has a cold sore and puts their finger in their mouth then a herpes infection whitlow may appear.
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. Prosector's paronychia is a primary inoculation of tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
of the skin and nails, named after its association with prosector
Prosector
A prosector is a person with the special task of preparing a dissection for demonstration, usually in medical schools or hospitals. Many important anatomists began their careers as prosectors working for lecturers and demonstrators in anatomy and pathology....
s, 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
Carcinoma
Carcinoma is the medical term for the most common type of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during...
of the larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
.
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.
Treatment
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 dicloxacillinDicloxacillin
Dicloxacillin is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It is used to treat infections caused by susceptible Gram-positive bacteria. It is active against beta-lactamase-producing organisms such as Staphylococcus aureus, which would otherwise be resistant to most...
. 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
Ketoconazole
Ketoconazole is a synthetic antifungal drug used to prevent and treat fungal skin infections, especially in immunocompromised patients such as those with AIDS or those on chemotherapy. Ketoconazole is sold commercially as an anti-dandruff shampoo, topical cream, and oral tablet.Ketoconazole is...
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.
External links
- "What Is The Best Way To Treat Paronychias?, Roundtable discussion in Podiatry Today, Volume 15 - Issue 3, March 2002, pp. 58–60.