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Paronychia

Last reviewed: 23 Jun 2024
Last updated: 25 Jun 2024

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)
Full details

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
  • medications (chronic)
  • toddler and adult
  • female
Full details

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

ACUTE

acute paronychia

ONGOING

chronic paronychia

retronychia

Contributors

Authors

Shirin Zaheri, MBBS, BSc, MRCP

Dermatology Consultant

Charing Cross Hospital

Imperial College NHS Trust

London

UK

Disclosures

SZ declares that she has no competing interests.

Khawar Hussain, BSc, MRCP, FHEA

Specialty Registrar in Dermatology

Charing Cross Hospital

Imperial College NHS Trust

London

UK

Disclosures

KH has been reimbursed by Sanofi for conference travel expenses.

Acknowledgements

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

Disclosures

NJJ, CH, and SN declare that they have no competing interests. CRD is an author of a number of references cited in this topic.

Peer reviewers

Shehla Admani, MD

Clinical Assistant Professor of Dermatology

Stanford University School of Medicine

San Jose

CA

Disclosures

SA declares that he has no competing interests.

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