Last reviewed: September 2018
Last updated: March  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain, swelling, drainage (acute)
  • swollen, purulent nail fold (acute)
  • nail plate irregularities (chronic)
  • swelling/redness of nail folds (chronic)
  • pink, swollen nail folds (chronic)
  • missing cuticle (chronic)
  • underlying nail plate abnormalities (chronic)

Risk factors

  • microscopic or macroscopic injury to the nail folds (acute)
  • occupational risks (acute and chronic)
  • barrier damage to the nail folds, cuticle (chronic)
  • ingrown nail
  • chemotherapeutic agents
  • toddler and adult
  • female

Diagnostic investigations

1st investigations to order

  • swab for Gram stain, culture, and sensitivity (acute or acute-on-chronic)
  • swab for Tzanck smear (acute, herpetic)
Full details

Investigations to consider

  • potassium hydroxide or fungal culture (chronic)
  • x-ray
  • MRI
  • biopsy of skin/bone
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Dermatology Registrar

Charing Cross Hospital

Imperial College NHS Trust

London

UK

Disclosures

SN declares that she has no competing interests.

Dermatology Consultant

Charing Cross Hospital

Imperial College NHS Trust

London

UK

Disclosures

SZ declares that she has no competing interests.

Consultant Dermatologist

St Mary’s Hospital

Paddington

London

UK

Disclosures

CH declares that she has no competing interests.

Dr Shaimaa Nassar, Dr Shirin Zaheri, and Dr Catherine Hardman would like to gratefully acknowledge Dr Nathaniel J. Jellinek and Professor C. Ralph Daniel III, previous contributors to this topic.

Peer reviewers VIEW ALL

Assistant Professor of Clinical Dermatology

Columbia University

New York

NY

Disclosures

RU declares that he has no competing interests.

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