Paronychia is an inflammation of the skin around the nail, which can occur suddly, wh it is usually due to the bacterium Staphylococcus aureus, or gradually wh it is commonly caused by the fungus Candida albicans.
Paronychia is an inflammation of the skin around the nail, which can occur suddly (acute), wh it is usually due to the bacterium Staphylococcus aureus, or gradually (chronic) wh it is commonly caused by Candida albicans.
The index and middle fingers are most commonly affected and may prest with redness, swelling and pain. Pus or discharge may be prest.
Ingrown Nails (onychocryptosis, Ingrown Toenails)
Acute paronychia is usually caused by bacteria. It is oft treated with antibiotics, either topical (applied to the skin) or oral (tak by mouth), or both. Chronic paronychia is most oft 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 oft fungal and needs antifungal cream or paint to be treated.
Prosector's paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specims for dissection. Paronychia around the tire 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.
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Acute paronychia is an infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting less than six weeks.
Acute paronychia is usually caused by direct or indirect trauma to the cuticle or nail fold, and may be from relatively minor evts, such as dishwashing, an injury from a splinter or thorn, nail biting, biting or picking at a hangnail, finger sucking, an ingrown nail, or manicure procedures.
Chronic paronychia is an infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting more than six weeks.
Ingrown Nail By Dr Etienne Swanepoel
It is a nail disease prevalt in individuals whose hands or feet are subject to moist local vironmts, and is oft due to contact dermatitis.
In chronic paronychia, the cuticle separates from the nail plate, leaving the region betwe the proximal nail fold and the nail plate vulnerable to infection.
It can be the result of dish washing, finger sucking, aggressively trimming the cuticles, or frequt contact with chemicals (mild alkalis, acids, etc.).
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Chronic paronychia is treated by avoiding whatever is causing it, a topical antifungal, and a topical steroid. In those who do not improve following these measures, oral antifungals and steroids may be used or the nail fold may be removed surgically.
No strong evidce has be found to recommd topical vs. oral antibiotics, and this may be physician-depdt based on experice. Antibiotics used should have S. aureus coverage. Topical antibiotics used may be a triple antibiotic ointmt, bacitracin, or mupirocin. In patits failing topical treatmt or more severe cases, oral antibiotics are an option; dicloxacillin or cephalexin can be used. Indications for antibiotics with anaerobic coverage include patits where a concern exists for oral inoculation; this would require the addition of clindamycin or amoxicillin-clavulanate.
Paronychia is more common in wom than in m, by a ratio of three to one. Usually, they affect manual-labor workers or people in occupations that require them to have their hands or feet submerged in water for prolonged periods (e.g., dishwashers). Middle-aged females are at the highest risk of infection.I see patients who come into the clinic for ingrown nails, most often toenails but even ingrown fingernails can bring people to the doctor.
San Luis Podiatry Group
Causes: occupations where the hands are in the water frequently, nail biting, thumb sucking, overzealous manicuring and even diabetes can lead to fingernail infections.
Ingrown toenail: The big toe is most commonly affected. Signs and symptoms can include pain, swelling, drainage and granulation tissue. It’s more common to get ingrown toenails from poor fitting shoes, toe trauma, excessive trimming of the lateral nail plate, or in patients who have a over-curvature of the nail which can be hereditary or acquired.
Acute nail infections are usually accompanied by redness, and pain at the sides of the nail, sometimes with a blister that can be filled with purulent material If the patient hasn’t been biting their nails, the infection is most often caused by Staphylococcus aureus or Steptococcus pyogenes or a combination of both. Different bacteria are often present if the patient is a nail biter.
Ingrown Toenail Treatment
Chronic nail infections are often associated with eczema, however it can also be complicated by a Candida or yeast infection of the nails.
Diagnosis: In the clinic we can usually tell that there is a nail infection by the appearance of the nail folds on examination. If a purulent fluid collection is present, the diagnosis is even easier to make.
Treatment: If the infection has come on rapidly (acute onset), the treatment usually involves warm compresses or soaks to the affected finger or toe for 20 minutes three times/day. Antibiotics that are taken orally may be helpful in severe causes. Topical antibiotics such as triple antibiotic ointment might be helpful after soaking the digit, but there isn’t a lot of research to support it.
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If there is an abscess present, incision and drainage is usually helpful in addition to the above treatments. We usually perform a digital block to numb the finger or toe for comfort before the surgery is performed. Treatment with antibiotics is common and we usually use them for 5 days after a surgical drainage and for 7-10 days if there is no drainage. The choice of the antibiotic depend on whether the patient has been biting the nails, and the patient’s history of drug allergies. Possible treatment options include dicloxacillin, Keflex (no no MRSA in suspected) or Bactrim. We may also add metronidazole or clindamycin to the regimen if the patient has been biting their nails.
For ingrown toenails that are mild, we may place a cotton wedge or dental floss underneath the lateral nail plate to relieve the pressure and doing the soaks in warm soapy water for 10-20 minutes 3x/day. If the ingrown nail is severe however, we usually perform a partial nail removal after doing a digital block to relieve the discomfort. Antibiotics may be prescribed after partial nail removal may be helpful, however evidence has not shown that antibiotics decrease the healing time.
Recurrent ingrown toenails: May require treatment with permanent nail ablation surgery using both surgical excision plus phenol ablation (chemical matricectomy). The keeps the toenail from returning.
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Post-op care after toenail removal: You should be able to put weight on both feet immediately after surgery, but walking will be uncomfortable. Some mild bruising and bleeding is normal after foot surgery. We usually apply some antibiotic ointment and 4×4” gauze, tube gauze and paper tape. After 24-48 hours, soak the affected toe in warm, soapy water and reapply antibiotic ointment and a clean bandage. This should be done 3-4x/day for 1-2 weeks after the procedure. Keep your foot and leg elevated while sitting or lying down and make sure your bandages are clean and dry at all times. We ask patients not to wear shoes for 3 days and recommend antibiotics and anti-inflammatory medications for 10 days.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
Dr. Rennie is a family physician practicing in Honolulu, Hawaii. He has special interests in telemedicine, weight loss, and urgent care. His focus is providing expert medical care with personalized service in the realm of urgent care, weight loss, diabetes, wilderness medicine, primary prevention, and whole-body wellness.Paronychia is inflammation of the skin around a finger or toenail. It can be acute (< 6 weeks) or chronic (persisting > 6 weeks).
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Acute paronychia can affect anyone. However, it is more likely to follow a break in the skin, especially between the proximal nail fold/cuticle and the nail plate. For example:
Acute and chronic skin infections tend to be more frequent and aggressive in patients with diabetes or chronic debility, or that are immune suppressed by drugs or disease.
, Pseudomonas, or other bacterial pathogens. It can also be due to the cold sore virus, Herpes simplex , and the yeast, Candida albicans.
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The cause or causes of chronic paronychia are not fully understood. In many cases, it is due to dermatitis of the nail fold. Often several different micro-organisms can be cultured, particularly
If herpes simplex is the cause, multiple tender vesicles may be observed. Sometimes yellow pus appears under the cuticle and can evolve to abscess . The nail plate may lift up (onycholysis ). Acute paronychia due to
Chronic paronychia is a gradual process. It may start in one nail fold, particularly the proximal nail fold, but often spreads laterally and to several other fingers. Each affected nail fold is swollen and lifted off the nail plate. This allows the entry of organisms and irritants. The affected skin may be red and tender from time to time, and sometimes a little pus (white, yellow or
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