Summary
Definition
History and exam
Key diagnostic 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)
Investigations to consider
- potassium hydroxide or fungal culture (chronic)
- x-ray
- MRI
- biopsy of skin/bone
Treatment algorithm
Contributors
Authors
Dermatology Consultant
Charing Cross Hospital
Imperial College NHS Trust
London
UK
Disclosures
SZ declares that she has no competing interests.
Specialty Registrar in Dermatology
Charing Cross Hospital
Imperial College NHS Trust
London
UK
Disclosures
KH declares that he has no competing interests.
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
Assistant Professor of Clinical Dermatology
Columbia University
New York
NY
Disclosures
RU declares that he has no competing interests.
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