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Paronychia
Superficial Infection of the fold of skin
surrounding a fingernail or toenail (nail fold) is called paronychia.
It usually results from injury to the area from biting
off or picking a hangnail, or from manipulating, trimming, or pushing back the
cuticle.
 It can be divided into acute paronychia and chronic
paronychia depending on the amount of time the infection has been present.
The infection causes pain and
swelling, which may develop either suddenly (acute paronychia) or gradually
over several months (chronic paronychia), depending on the underlying cause.
One or more nails may be affected by the condition.
The Disorders include:
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bacterial paronychia (caused by bacteria)
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Candida paronychia (caused by a specific type of yeast)
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fungal paronychia (caused by a fungus other than Candida)
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 What
are the Causes?
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Paronychia is usually the result of:
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 A bacterial infection entering the nail fold through a cut. The most
common bacteria responsible is Staphylococcus aureus. Other bacteria
that are less commonly involved are Streptococcus species and
Pseudomonas species.
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Break in the skin caused byrepeated injury of the cuticle skin,
such as in vigorous
manicures.The skin around the nail separates from the nail,
softens, and becomes infected, usually by a yeast organism.A secondary
bacterial infection may then occur, resulting in acute paronychia.
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Repetitive soaking of hands in water at work or at home. Common among
people such as cooks
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Excessive hand washing, especially when the hands are not dried properly
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Some
people with decreased resistance to infection, such as those with
diabetes mellitusm, are at increased risk of paronychia.
Fungal paronychia is common among people with diabetes
and among people who have their hands in water for long periods of time.
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What
are the Symptoms?
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Usually, the symptoms of acute paronychia become apparent
about 24 hours after infection and include:
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Skin lesion (Rashes involve changes in the color or texture of your skin)
located in the skin around the nail, often at the
cuticle or at the site of a
hangnail or other injury
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painful
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onset sudden (bacterial) or gradual (fungal, mixed infection)
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may persist (fungal, mixed infection)
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may be
acute or
chronic
redness, localized
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swelling, localized
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swelling of the finger or the cuticle
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Eventually, the affected nail thickens slightly and develops horizontal
ridges and brownish discoloration.
If acute paronychia is left
untreated, the nail may separate from the nail bed and eventually fall.
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Diagnosis
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Paronychia can be diagnosed from the appearance of the nail and
its surrounding skin. Sometimes
Aspiration and culture is done to identify the organism causing the infection. For a culture, a
sample of the pus is collected and sent to the laboratory for examination under
a microscope.
A potassium hydroxide (KOH) test of a smear from the nail fold
can sometimes reveal a fungus.
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Treatment Options
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Warm soaks can be used 3 or 4 times a day for acute
paronychia to promote drainage and relieve some of the pain. Your doctor may prescribe oral antibiotics
such as cephalexin or dicloxacillin, for acute paronychia. In severe cases, pus may be drained under local anaesthesia. 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. Acute paronychia often clears up in a few days with treatment.
Chronic paronychia may be treated with an over - the -
counter cream containing containing an antifungal drug, but if there is a secondary infection your doctor may prescribe
stronger antifungals and oral antibiotics. 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.Chronic paronychia
take several weeks. Avoid predisposing factors such as exposure to irritating
substances, prolonged exposure to water, manicures, nail trauma and finger
sucking.
The hands should be kept dry, or, topical drying
agents such as Castellani's paint should be applied
Excellent results have been reported with the use of an eponychial
marsupialization technique, as well as removal of the entire nail and
application of an antifungal-steroid ointment to the nail bed.
Eponychial Marsupialization Technique
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In this technique,
the affected digit is first anesthetized with 1% Xylocaine (lidocaine) with
no epinephrine by using the digital ring block method.
Tourniquet control of the proximal digit is accomplished by using a finger
of a latex glove with the distal end cut off.
With a number-15 blade, a crescent-shaped incision is made proximal to the
distal edge of the eponychial fold.
The distal incision is made approximately 1 mm proximal to the distal edge
of the eponychium and along its curve.
At its widest end, the proximal incision is approximately 5 mm from the
distal incision.
The incision should appear symmetric and extend to the edge of the nail fold
on each side.
All affected tissue within the boundaries of the crescent and extending down
to, but not including, the germinal matrix is excised. In effect, this
procedure exteriorizes the infected and obstructed nail matrix and allows
its drainage.
If the nail plate is grossly deformed at the time of surgery, it may be
removed.
The excised region is packed with plain gauze wick, which is changed every
2-3 days.
Epithelialization of the excised defect occurs over the next 2-3 weeks.
Nail improvement occurs over the next 6-9 months but may require as long as
12 months to become apparent
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Treatment Options
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Lifestyle Modifications
To prevent paronychia,
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Dry your hands thoroughly after washing and
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Wear cotton - lined rubber gloves when your hands are in water.
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Do not bite nails or cuticles
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Do not suck fingers
Diet: No change in diet is required.
Repeated immersion of the hands in water is a risk
factor.
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Related Links
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