Paronychia

This article is about the nail disease. For the genus of plants, see Paronychia (plant).
Not to be confused with whitlow.
Paronychia
Classification and external resources
Specialty Dermatology, emergency medicine
ICD-10 L03.0
ICD-9-CM 681.02, 681.11
DiseasesDB 9663
MedlinePlus 001444
eMedicine derm/798
MeSH D010304

A paronychia (/ˌpærəˈnɪkiə/; Greek: παρωνυχία from para, "around" and onukh-, "nail") is a nail disease that is an often-tender bacterial or fungal infection of the hand or foot 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).[1][2] Paronychia is commonly misapplied as a synonym for whitlow or felon.

Types

Left and right ring fingers of the same individual. The distal phalanx of the finger on the right exhibits swelling due to acute paronychia.

Paronychia may be divided as follows:[3]

Alternatively, paronychia may be divided as follows:[4]

Signs and symptoms

An infection of the cuticle secondary to a splinter

The skin typically presents as red and hot. These infections can be painful.

Pus is usually present, along with gradual thickening and browning discoloration of the nail plate.

Cause

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.[9]

Risk factors include repeatedly washing hands and trauma to the cuticle such as from biting. In the context of bartending, it is known as bar rot.[10][11]

Herpes whitlows are frequently found among dentists and dental hygienists.[12] Prosector's paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, 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.[13]

Paronychia can occur with diabetes, drug-induced immunosuppression,[14] or systemic diseases such as pemphigus.[15]

Treatment

When no pus is present warm soaks for acute paronychia is reasonable, even though there is a lack of evidence to support its use.[6] Antibiotics such as clindamycin or cephalexin are also often used, the first being more effective in areas where MRSA is common.[6] If there are signs of an abscess (the presence of pus) drainage is recommended.[6]

Chronic paronychia is treated by avoiding whatever is causing it, and applying a topical antifungal and a topical steroid.[8] In those who do not improve following these measures oral antifungals and steroids may be used or the nail fold may be removed surgically.[8]

References

  1. ↑ Rigopoulos D, Larios G, Gregoriou S, Alevizos A (February 2008). "Acute and chronic paronychia". Am Fam Physician. 77 (3): 339–46. PMID 18297959.
  2. 1 2 3 4 Rockwell PG (March 2001). "Acute and chronic paronychia". Am Fam Physician. 63 (6): 1113–6. PMID 11277548.
  3. 1 2 3 James, William D.; Berger, Timothy G. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
  4. 1 2 3 Freedberg, Irwin M., ed. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill Publishing Company. ISBN 0071380760.
  5. ↑ Rigopoulos, Dimitris; Larios, George; Gregoriou, Stamatis; Alevizos, Alevizos (2008). "Acute and Chronic Paronychia" (PDF). American Family Physician. 77 (3): 339–346. PMID 18297959. Retrieved January 7, 2013.
  6. 1 2 3 4 5 6 Ritting, AW; O'Malley, MP; Rodner, CM (May 2012). "Acute paronychia.". The Journal of hand surgery. 37 (5): 1068–70; quiz page 1070. doi:10.1016/j.jhsa.2011.11.021. PMID 22305431.
  7. ↑ Rigopoulos, Dimitris; Larios, George; Gregoriou, Stamatis; Alevizos, Alevizos (2008). "Acute and Chronic Paronychia" (PDF). American Family Physician. 77 (3): 339–346. PMID 18297959. Retrieved January 8, 2013.
  8. 1 2 3 4 Rigopoulos, D; Larios, G; Gregoriou, S; Alevizos, A (Feb 1, 2008). "Acute and chronic paronychia.". American family physician. 77 (3): 339–46. PMID 18297959.
  9. ↑ "Doctor's advice Q: Whitlow (paronychia)". bbc.co.uk. Retrieved 2008-05-10.
  10. ↑ Fred Ashley White (2009). Physical Signs in Medicine and Surgery: An Atlas of Rare, Lost and Forgotten Physical Signs : Includes a Collection of Extraordinary Papers in Medicine, Surgery and the Scientific Method. Museum Press Books. p. 37. ISBN 978-1-4415-0829-4.
  11. ↑ "Bar Rot". The Truth About Bartending. January 27, 2012. Archived from the original on 2013-03-22.
  12. ↑ Lewis MA (2004). "Herpes simplex virus: an occupational hazard in dentistry". Int Dent J. 54 (2): 103–11. doi:10.2956/indj.2004.54.2.103 (inactive 2015-01-09). PMID 15119801.
  13. ↑ Karen Allen, MD (2005-08-17). "eMedicine - Acrokeratosis Neoplastica".
  14. ↑ Paronychia~clinical at eMedicine
  15. ↑ http://dermatology-s10.cdlib.org/1507/reviews/nail_pemphigus/rashid.html[]
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