Paronychia is a common infection that affects the skin surrounding a fingernail or toenail. Bacteria usually cause it, but fungi or viruses can also cause it. The condition can be acute or chronic, and it is often painful and can result in swelling, redness, and pus-filled blisters. Acute paronychia typically develops over a few hours or days and is characterized by sudden pain, redness, and swelling around the affected nail. On the other hand, chronic paronychia is a long-term condition that develops gradually and may be associated with nail or surrounding skin damage.
If left untreated, paronychia can lead to severe complications, such as spreading the infection to the rest of the body, abscess formation, and even loss of the affected nail. Treatment typically involves draining any pus or fluid from the affected area and taking antibiotics or antifungal medication, depending on the underlying cause. In some cases, surgery may be necessary to remove any damaged tissue or to drain an abscess.
Epidemiology
Paronychia is a common condition that affects people of all ages. The exact prevalence of paronychia has yet to be discovered, as many cases may go unreported or untreated. However, some studies suggest that acute paronychia accounts for up to 10% of hand infections seen in emergency departments, while chronic paronychia is estimated to affect up to 5% of the general population.
Paronychia can occur in anyone, but certain factors may increase the risk of developing the condition. For example, paronychia is more common in people who work in jobs that require frequent hand washing or exposure to water, such as healthcare workers or food handlers. People with diabetes or other conditions that affect circulation may also be at increased risk of developing paronychia.
Paronychia can occur at any time of year, but it may be more common during the winter months, when cold and dry weather can cause the skin to become dry and cracked, making it more prone to infection. There is no significant difference in the incidence of paronychia between men and women, and it can affect any finger or toe. However, paronychia is more commonly seen in the fingers than the toes, as the hands are more frequently exposed to trauma and microorganisms.
Anatomy
Pathophysiology
Paronychia is an inflammatory response of the soft tissue surrounding the nail caused by an infection. The infection typically starts with a break in the skin around the nail, which can be caused by trauma, such as biting the nail or a hangnail, or by chronic exposure to moisture. Bacteria, fungi, or viruses can enter the wound and cause an infection, leading to an inflammatory response. This inflammatory response causes redness, swelling, and pain around the affected nail.
Pus may also form in the area, a sign of infection. In acute paronychia, the infection typically stays localized to the area around the nail, and the body’s immune response can clear the infection within a few days. However, if the infection is not treated, it can spread and lead to complications such as an abscess, cellulitis, or osteomyelitis. In chronic paronychia, the infection may persist for weeks or months, and the inflammation may cause changes to the nail, such as thickening or discoloration.
Chronic paronychia may be associated with an underlying condition, such as eczema or psoriasis, making the skin more prone to infection. The pathophysiology of paronychia involves a complex interaction between the immune system, microorganisms, and the skin surrounding the nail. Treatment typically involves controlling the infection with antibiotics or antifungal medication and addressing any underlying conditions contributing to the infection.
Etiology
A bacterial infection usually causes paronychia, but other microorganisms, such as fungi and viruses, can also cause it. The most common bacterial cause of paronychia is Staphylococcus aureus, commonly found on the skin. Other bacteria that can cause paronychia include Streptococcus species, Pseudomonas aeruginosa, and Proteus mirabilis.
Fungal paronychia is typically caused by a type of yeast called Candida albicans, which can overgrow in warm and moist environments, such as around the nails. Other types of fungi, such as dermatophytes, can also cause fungal paronychia. Paronychia can sometimes be caused by a viral infection, such as herpes simplex virus or human papillomavirus (HPV).
Risk factors for developing paronychia include:
Trauma to the nail or surrounding skin, such as biting your nails or getting a manicure or pedicure.
Excessive moisture or wetness around the nail, such as prolonged water exposure or wearing tight-fitting gloves.
Chronic medical conditions, such as diabetes or peripheral vascular disease, can increase the risk of infection.
Immunosuppression, such as from HIV or chemotherapy, can make developing infections easier.
Certain medications, such as immunosuppressants or chemotherapy drugs, can increase the risk of infection.
Genetics
Prognostic Factors
The prognosis of paronychia is generally good, with most cases responding well to treatment and resolving within a few weeks. Acute paronychia typically resolves within a few days to a week with proper treatment, while chronic paronychia may take several weeks or months to resolve. Paronychia can sometimes lead to complications such as cellulitis or osteomyelitis, especially if left untreated or if the infection spreads to deeper tissues.
However, these complications can usually be prevented with prompt diagnosis and treatment. Patients with chronic paronychia may be at increased risk for recurring infections and require ongoing management and lifestyle modifications to prevent future episodes. It is essential to seek medical attention promptly if you suspect you have paronychia or have symptoms of infection around your nails. Early diagnosis and treatment can improve outcomes and reduce the risk of complications.
Clinical History
Clinical history
The clinical history of paronychia typically involves patients reporting symptoms such as pain, redness, and swelling around the affected nail. The patient may also report a recent injury or trauma to the nail or surrounding skin, such as a hangnail or a crush injury. In acute paronychia, the symptoms typically develop rapidly over a few days and may be accompanied by the formation of pus around the nail. The area around the nail may be warm to the touch, and the patient may experience fever or chills if the infection is severe.
In chronic paronychia, the symptoms may develop more slowly over a period of weeks or months, and the patient may report a history of recurring episodes of inflammation around the nail. The patient may also report a history of exposure to moisture or irritants, such as frequent hand washing or exposure to chemicals, which can contribute to developing chronic paronychia.
Patients with paronychia may also report underlying medical conditions, such as diabetes or peripheral vascular disease, which can increase the risk of developing the condition. Patients with chronic paronychia may also report a history of skin conditions such as eczema or psoriasis, which can make the skin more prone to infection. A thorough clinical history and a physical exam can help a healthcare provider diagnose paronychia and determine the appropriate treatment plan.
Physical Examination
Physical examination
During a physical examination for paronychia, the healthcare provider will evaluate the affected finger or toe for signs of inflammation and infection. They typically start by inspecting the skin around the nail, looking for redness, swelling, and tenderness. They may also look for signs of pus or discharge, which can be a sign of infection. The provider will also examine the nail itself, looking for signs of damage or deformity.
If there is significant swelling or inflammation, it may be difficult to see the nail clearly. However, the provider will still assess for any changes in color or texture that may indicate an underlying problem. In cases of acute paronychia, the provider may perform a simple procedure called paronychia drainage to help relieve the pressure caused by the buildup of pus around the nail.
During this procedure, the provider will use a sterile instrument to puncture the skin and drain the pus, which can immediately relieve symptoms. In cases of chronic paronychia, the provider may look for signs of skin conditions such as eczema or psoriasis, which can make the skin more susceptible to infection. They may also ask about the patient’s occupation and hobbies, as frequent exposure to water or irritants can contribute to the development of chronic paronychia.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential diagnosis
Paronychia can be easily recognized based on clinical features such as redness, swelling, and tenderness around the nail, and sometimes with the discharge of pus. However, other conditions may present similar symptoms, making differential diagnosis necessary. Some of the conditions that can be confused with paronychia include:
Herpetic whitlow: A viral infection caused by herpes simplex virus that affects the fingers or toes. It can cause small, painful blisters that can look like paronychia.
Cellulitis: A bacterial skin infection that can cause redness, swelling, and pain around the affected area. Cellulitis can sometimes be mistaken for paronychia, as it can also occur around the nail.
Osteomyelitis: A bone infection that can occur in the finger or toe bones due to the spread of infection from the soft tissue. It can cause pain, swelling, and tenderness around the affected bone.
Gout: A type of arthritis caused by the buildup of uric acid crystals in the joints, which can cause redness, swelling, and severe pain in the affected joint. Gout can sometimes occur in the finger or toe joints and can be mistaken for paronychia.
Eczema or psoriasis: Chronic skin conditions that can cause redness, scaling, and inflammation around the nails, which can be mistaken for chronic paronychia.
Trauma: Injuries to the nail or surrounding skin, such as a crush injury, can cause symptoms similar to acute paronychia.
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment of paronychia depends on the severity of the infection and the type of paronychia present. Acute paronychia is typically treated with self-care measures and antibiotics, while chronic paronychia may require a more prolonged treatment and lifestyle modifications. For acute paronychia, initial treatment may involve soaking the affected finger or toe in warm water for 15-20 minutes several times a day to help reduce inflammation and promote drainage of pus.
If there is no improvement or the infection appears to be spreading, a healthcare provider may prescribe antibiotics such as dicloxacillin, cephalexin, or clindamycin. In cases with a significant amount of pus or fluid buildup, the provider may perform a simple procedure called paronychia drainage to help relieve the pressure and improve healing.
This involves using a sterile instrument to puncture the skin and drain the pus. Chronic paronychia may require aggressive treatment and lifestyle modifications to prevent recurring infections. Treatment may involve topical or oral antifungal medications, topical or oral antibiotics, and corticosteroid creams to reduce inflammation.
In addition, lifestyle modifications may be recommended to help prevent recurring infections. This can include avoiding exposure to irritants such as chemicals or moisture, keeping the affected area clean and dry, and avoiding nail-biting or other habits that can damage the nail and surrounding skin. Surgery may be necessary in rare cases with significant deformity or damage to the nail or surrounding tissues or if the infection does not respond to other treatments.
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References
https://www.ncbi.nlm.nih.gov/books/NBK544307/
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Paronychia is a common infection that affects the skin surrounding a fingernail or toenail. Bacteria usually cause it, but fungi or viruses can also cause it. The condition can be acute or chronic, and it is often painful and can result in swelling, redness, and pus-filled blisters. Acute paronychia typically develops over a few hours or days and is characterized by sudden pain, redness, and swelling around the affected nail. On the other hand, chronic paronychia is a long-term condition that develops gradually and may be associated with nail or surrounding skin damage.
If left untreated, paronychia can lead to severe complications, such as spreading the infection to the rest of the body, abscess formation, and even loss of the affected nail. Treatment typically involves draining any pus or fluid from the affected area and taking antibiotics or antifungal medication, depending on the underlying cause. In some cases, surgery may be necessary to remove any damaged tissue or to drain an abscess.
Paronychia is a common condition that affects people of all ages. The exact prevalence of paronychia has yet to be discovered, as many cases may go unreported or untreated. However, some studies suggest that acute paronychia accounts for up to 10% of hand infections seen in emergency departments, while chronic paronychia is estimated to affect up to 5% of the general population.
Paronychia can occur in anyone, but certain factors may increase the risk of developing the condition. For example, paronychia is more common in people who work in jobs that require frequent hand washing or exposure to water, such as healthcare workers or food handlers. People with diabetes or other conditions that affect circulation may also be at increased risk of developing paronychia.
Paronychia can occur at any time of year, but it may be more common during the winter months, when cold and dry weather can cause the skin to become dry and cracked, making it more prone to infection. There is no significant difference in the incidence of paronychia between men and women, and it can affect any finger or toe. However, paronychia is more commonly seen in the fingers than the toes, as the hands are more frequently exposed to trauma and microorganisms.
Paronychia is an inflammatory response of the soft tissue surrounding the nail caused by an infection. The infection typically starts with a break in the skin around the nail, which can be caused by trauma, such as biting the nail or a hangnail, or by chronic exposure to moisture. Bacteria, fungi, or viruses can enter the wound and cause an infection, leading to an inflammatory response. This inflammatory response causes redness, swelling, and pain around the affected nail.
Pus may also form in the area, a sign of infection. In acute paronychia, the infection typically stays localized to the area around the nail, and the body’s immune response can clear the infection within a few days. However, if the infection is not treated, it can spread and lead to complications such as an abscess, cellulitis, or osteomyelitis. In chronic paronychia, the infection may persist for weeks or months, and the inflammation may cause changes to the nail, such as thickening or discoloration.
Chronic paronychia may be associated with an underlying condition, such as eczema or psoriasis, making the skin more prone to infection. The pathophysiology of paronychia involves a complex interaction between the immune system, microorganisms, and the skin surrounding the nail. Treatment typically involves controlling the infection with antibiotics or antifungal medication and addressing any underlying conditions contributing to the infection.
A bacterial infection usually causes paronychia, but other microorganisms, such as fungi and viruses, can also cause it. The most common bacterial cause of paronychia is Staphylococcus aureus, commonly found on the skin. Other bacteria that can cause paronychia include Streptococcus species, Pseudomonas aeruginosa, and Proteus mirabilis.
Fungal paronychia is typically caused by a type of yeast called Candida albicans, which can overgrow in warm and moist environments, such as around the nails. Other types of fungi, such as dermatophytes, can also cause fungal paronychia. Paronychia can sometimes be caused by a viral infection, such as herpes simplex virus or human papillomavirus (HPV).
Risk factors for developing paronychia include:
Trauma to the nail or surrounding skin, such as biting your nails or getting a manicure or pedicure.
Excessive moisture or wetness around the nail, such as prolonged water exposure or wearing tight-fitting gloves.
Chronic medical conditions, such as diabetes or peripheral vascular disease, can increase the risk of infection.
Immunosuppression, such as from HIV or chemotherapy, can make developing infections easier.
Certain medications, such as immunosuppressants or chemotherapy drugs, can increase the risk of infection.
The prognosis of paronychia is generally good, with most cases responding well to treatment and resolving within a few weeks. Acute paronychia typically resolves within a few days to a week with proper treatment, while chronic paronychia may take several weeks or months to resolve. Paronychia can sometimes lead to complications such as cellulitis or osteomyelitis, especially if left untreated or if the infection spreads to deeper tissues.
However, these complications can usually be prevented with prompt diagnosis and treatment. Patients with chronic paronychia may be at increased risk for recurring infections and require ongoing management and lifestyle modifications to prevent future episodes. It is essential to seek medical attention promptly if you suspect you have paronychia or have symptoms of infection around your nails. Early diagnosis and treatment can improve outcomes and reduce the risk of complications.
Clinical history
The clinical history of paronychia typically involves patients reporting symptoms such as pain, redness, and swelling around the affected nail. The patient may also report a recent injury or trauma to the nail or surrounding skin, such as a hangnail or a crush injury. In acute paronychia, the symptoms typically develop rapidly over a few days and may be accompanied by the formation of pus around the nail. The area around the nail may be warm to the touch, and the patient may experience fever or chills if the infection is severe.
In chronic paronychia, the symptoms may develop more slowly over a period of weeks or months, and the patient may report a history of recurring episodes of inflammation around the nail. The patient may also report a history of exposure to moisture or irritants, such as frequent hand washing or exposure to chemicals, which can contribute to developing chronic paronychia.
Patients with paronychia may also report underlying medical conditions, such as diabetes or peripheral vascular disease, which can increase the risk of developing the condition. Patients with chronic paronychia may also report a history of skin conditions such as eczema or psoriasis, which can make the skin more prone to infection. A thorough clinical history and a physical exam can help a healthcare provider diagnose paronychia and determine the appropriate treatment plan.
Physical examination
During a physical examination for paronychia, the healthcare provider will evaluate the affected finger or toe for signs of inflammation and infection. They typically start by inspecting the skin around the nail, looking for redness, swelling, and tenderness. They may also look for signs of pus or discharge, which can be a sign of infection. The provider will also examine the nail itself, looking for signs of damage or deformity.
If there is significant swelling or inflammation, it may be difficult to see the nail clearly. However, the provider will still assess for any changes in color or texture that may indicate an underlying problem. In cases of acute paronychia, the provider may perform a simple procedure called paronychia drainage to help relieve the pressure caused by the buildup of pus around the nail.
During this procedure, the provider will use a sterile instrument to puncture the skin and drain the pus, which can immediately relieve symptoms. In cases of chronic paronychia, the provider may look for signs of skin conditions such as eczema or psoriasis, which can make the skin more susceptible to infection. They may also ask about the patient’s occupation and hobbies, as frequent exposure to water or irritants can contribute to the development of chronic paronychia.
Differential diagnosis
Paronychia can be easily recognized based on clinical features such as redness, swelling, and tenderness around the nail, and sometimes with the discharge of pus. However, other conditions may present similar symptoms, making differential diagnosis necessary. Some of the conditions that can be confused with paronychia include:
Herpetic whitlow: A viral infection caused by herpes simplex virus that affects the fingers or toes. It can cause small, painful blisters that can look like paronychia.
Cellulitis: A bacterial skin infection that can cause redness, swelling, and pain around the affected area. Cellulitis can sometimes be mistaken for paronychia, as it can also occur around the nail.
Osteomyelitis: A bone infection that can occur in the finger or toe bones due to the spread of infection from the soft tissue. It can cause pain, swelling, and tenderness around the affected bone.
Gout: A type of arthritis caused by the buildup of uric acid crystals in the joints, which can cause redness, swelling, and severe pain in the affected joint. Gout can sometimes occur in the finger or toe joints and can be mistaken for paronychia.
Eczema or psoriasis: Chronic skin conditions that can cause redness, scaling, and inflammation around the nails, which can be mistaken for chronic paronychia.
Trauma: Injuries to the nail or surrounding skin, such as a crush injury, can cause symptoms similar to acute paronychia.
The treatment of paronychia depends on the severity of the infection and the type of paronychia present. Acute paronychia is typically treated with self-care measures and antibiotics, while chronic paronychia may require a more prolonged treatment and lifestyle modifications. For acute paronychia, initial treatment may involve soaking the affected finger or toe in warm water for 15-20 minutes several times a day to help reduce inflammation and promote drainage of pus.
If there is no improvement or the infection appears to be spreading, a healthcare provider may prescribe antibiotics such as dicloxacillin, cephalexin, or clindamycin. In cases with a significant amount of pus or fluid buildup, the provider may perform a simple procedure called paronychia drainage to help relieve the pressure and improve healing.
This involves using a sterile instrument to puncture the skin and drain the pus. Chronic paronychia may require aggressive treatment and lifestyle modifications to prevent recurring infections. Treatment may involve topical or oral antifungal medications, topical or oral antibiotics, and corticosteroid creams to reduce inflammation.
In addition, lifestyle modifications may be recommended to help prevent recurring infections. This can include avoiding exposure to irritants such as chemicals or moisture, keeping the affected area clean and dry, and avoiding nail-biting or other habits that can damage the nail and surrounding skin. Surgery may be necessary in rare cases with significant deformity or damage to the nail or surrounding tissues or if the infection does not respond to other treatments.
https://www.ncbi.nlm.nih.gov/books/NBK544307/
medtigo
Paronychia
Updated :
August 24, 2023
Paronychia is a common infection that affects the skin surrounding a fingernail or toenail. Bacteria usually cause it, but fungi or viruses can also cause it. The condition can be acute or chronic, and it is often painful and can result in swelling, redness, and pus-filled blisters. Acute paronychia typically develops over a few hours or days and is characterized by sudden pain, redness, and swelling around the affected nail. On the other hand, chronic paronychia is a long-term condition that develops gradually and may be associated with nail or surrounding skin damage.
If left untreated, paronychia can lead to severe complications, such as spreading the infection to the rest of the body, abscess formation, and even loss of the affected nail. Treatment typically involves draining any pus or fluid from the affected area and taking antibiotics or antifungal medication, depending on the underlying cause. In some cases, surgery may be necessary to remove any damaged tissue or to drain an abscess.
Paronychia is a common condition that affects people of all ages. The exact prevalence of paronychia has yet to be discovered, as many cases may go unreported or untreated. However, some studies suggest that acute paronychia accounts for up to 10% of hand infections seen in emergency departments, while chronic paronychia is estimated to affect up to 5% of the general population.
Paronychia can occur in anyone, but certain factors may increase the risk of developing the condition. For example, paronychia is more common in people who work in jobs that require frequent hand washing or exposure to water, such as healthcare workers or food handlers. People with diabetes or other conditions that affect circulation may also be at increased risk of developing paronychia.
Paronychia can occur at any time of year, but it may be more common during the winter months, when cold and dry weather can cause the skin to become dry and cracked, making it more prone to infection. There is no significant difference in the incidence of paronychia between men and women, and it can affect any finger or toe. However, paronychia is more commonly seen in the fingers than the toes, as the hands are more frequently exposed to trauma and microorganisms.
Paronychia is an inflammatory response of the soft tissue surrounding the nail caused by an infection. The infection typically starts with a break in the skin around the nail, which can be caused by trauma, such as biting the nail or a hangnail, or by chronic exposure to moisture. Bacteria, fungi, or viruses can enter the wound and cause an infection, leading to an inflammatory response. This inflammatory response causes redness, swelling, and pain around the affected nail.
Pus may also form in the area, a sign of infection. In acute paronychia, the infection typically stays localized to the area around the nail, and the body’s immune response can clear the infection within a few days. However, if the infection is not treated, it can spread and lead to complications such as an abscess, cellulitis, or osteomyelitis. In chronic paronychia, the infection may persist for weeks or months, and the inflammation may cause changes to the nail, such as thickening or discoloration.
Chronic paronychia may be associated with an underlying condition, such as eczema or psoriasis, making the skin more prone to infection. The pathophysiology of paronychia involves a complex interaction between the immune system, microorganisms, and the skin surrounding the nail. Treatment typically involves controlling the infection with antibiotics or antifungal medication and addressing any underlying conditions contributing to the infection.
A bacterial infection usually causes paronychia, but other microorganisms, such as fungi and viruses, can also cause it. The most common bacterial cause of paronychia is Staphylococcus aureus, commonly found on the skin. Other bacteria that can cause paronychia include Streptococcus species, Pseudomonas aeruginosa, and Proteus mirabilis.
Fungal paronychia is typically caused by a type of yeast called Candida albicans, which can overgrow in warm and moist environments, such as around the nails. Other types of fungi, such as dermatophytes, can also cause fungal paronychia. Paronychia can sometimes be caused by a viral infection, such as herpes simplex virus or human papillomavirus (HPV).
Risk factors for developing paronychia include:
Trauma to the nail or surrounding skin, such as biting your nails or getting a manicure or pedicure.
Excessive moisture or wetness around the nail, such as prolonged water exposure or wearing tight-fitting gloves.
Chronic medical conditions, such as diabetes or peripheral vascular disease, can increase the risk of infection.
Immunosuppression, such as from HIV or chemotherapy, can make developing infections easier.
Certain medications, such as immunosuppressants or chemotherapy drugs, can increase the risk of infection.
The prognosis of paronychia is generally good, with most cases responding well to treatment and resolving within a few weeks. Acute paronychia typically resolves within a few days to a week with proper treatment, while chronic paronychia may take several weeks or months to resolve. Paronychia can sometimes lead to complications such as cellulitis or osteomyelitis, especially if left untreated or if the infection spreads to deeper tissues.
However, these complications can usually be prevented with prompt diagnosis and treatment. Patients with chronic paronychia may be at increased risk for recurring infections and require ongoing management and lifestyle modifications to prevent future episodes. It is essential to seek medical attention promptly if you suspect you have paronychia or have symptoms of infection around your nails. Early diagnosis and treatment can improve outcomes and reduce the risk of complications.
Clinical history
The clinical history of paronychia typically involves patients reporting symptoms such as pain, redness, and swelling around the affected nail. The patient may also report a recent injury or trauma to the nail or surrounding skin, such as a hangnail or a crush injury. In acute paronychia, the symptoms typically develop rapidly over a few days and may be accompanied by the formation of pus around the nail. The area around the nail may be warm to the touch, and the patient may experience fever or chills if the infection is severe.
In chronic paronychia, the symptoms may develop more slowly over a period of weeks or months, and the patient may report a history of recurring episodes of inflammation around the nail. The patient may also report a history of exposure to moisture or irritants, such as frequent hand washing or exposure to chemicals, which can contribute to developing chronic paronychia.
Patients with paronychia may also report underlying medical conditions, such as diabetes or peripheral vascular disease, which can increase the risk of developing the condition. Patients with chronic paronychia may also report a history of skin conditions such as eczema or psoriasis, which can make the skin more prone to infection. A thorough clinical history and a physical exam can help a healthcare provider diagnose paronychia and determine the appropriate treatment plan.
Physical examination
During a physical examination for paronychia, the healthcare provider will evaluate the affected finger or toe for signs of inflammation and infection. They typically start by inspecting the skin around the nail, looking for redness, swelling, and tenderness. They may also look for signs of pus or discharge, which can be a sign of infection. The provider will also examine the nail itself, looking for signs of damage or deformity.
If there is significant swelling or inflammation, it may be difficult to see the nail clearly. However, the provider will still assess for any changes in color or texture that may indicate an underlying problem. In cases of acute paronychia, the provider may perform a simple procedure called paronychia drainage to help relieve the pressure caused by the buildup of pus around the nail.
During this procedure, the provider will use a sterile instrument to puncture the skin and drain the pus, which can immediately relieve symptoms. In cases of chronic paronychia, the provider may look for signs of skin conditions such as eczema or psoriasis, which can make the skin more susceptible to infection. They may also ask about the patient’s occupation and hobbies, as frequent exposure to water or irritants can contribute to the development of chronic paronychia.
Differential diagnosis
Paronychia can be easily recognized based on clinical features such as redness, swelling, and tenderness around the nail, and sometimes with the discharge of pus. However, other conditions may present similar symptoms, making differential diagnosis necessary. Some of the conditions that can be confused with paronychia include:
Herpetic whitlow: A viral infection caused by herpes simplex virus that affects the fingers or toes. It can cause small, painful blisters that can look like paronychia.
Cellulitis: A bacterial skin infection that can cause redness, swelling, and pain around the affected area. Cellulitis can sometimes be mistaken for paronychia, as it can also occur around the nail.
Osteomyelitis: A bone infection that can occur in the finger or toe bones due to the spread of infection from the soft tissue. It can cause pain, swelling, and tenderness around the affected bone.
Gout: A type of arthritis caused by the buildup of uric acid crystals in the joints, which can cause redness, swelling, and severe pain in the affected joint. Gout can sometimes occur in the finger or toe joints and can be mistaken for paronychia.
Eczema or psoriasis: Chronic skin conditions that can cause redness, scaling, and inflammation around the nails, which can be mistaken for chronic paronychia.
Trauma: Injuries to the nail or surrounding skin, such as a crush injury, can cause symptoms similar to acute paronychia.
The treatment of paronychia depends on the severity of the infection and the type of paronychia present. Acute paronychia is typically treated with self-care measures and antibiotics, while chronic paronychia may require a more prolonged treatment and lifestyle modifications. For acute paronychia, initial treatment may involve soaking the affected finger or toe in warm water for 15-20 minutes several times a day to help reduce inflammation and promote drainage of pus.
If there is no improvement or the infection appears to be spreading, a healthcare provider may prescribe antibiotics such as dicloxacillin, cephalexin, or clindamycin. In cases with a significant amount of pus or fluid buildup, the provider may perform a simple procedure called paronychia drainage to help relieve the pressure and improve healing.
This involves using a sterile instrument to puncture the skin and drain the pus. Chronic paronychia may require aggressive treatment and lifestyle modifications to prevent recurring infections. Treatment may involve topical or oral antifungal medications, topical or oral antibiotics, and corticosteroid creams to reduce inflammation.
In addition, lifestyle modifications may be recommended to help prevent recurring infections. This can include avoiding exposure to irritants such as chemicals or moisture, keeping the affected area clean and dry, and avoiding nail-biting or other habits that can damage the nail and surrounding skin. Surgery may be necessary in rare cases with significant deformity or damage to the nail or surrounding tissues or if the infection does not respond to other treatments.
https://www.ncbi.nlm.nih.gov/books/NBK544307/
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