Acute paronychia is an acute infection of the nail folds and periungual tissues, usually caused by Staphylococcus aureus.
Treatment of acute paronychia includes incision and drainage of any purulent fluid, soaks, and topical and/or oral antibacterials.
Chronic paronychia is a chronic irritant dermatitis of the periungual tissues resulting from barrier damage to the protective nail tissues, including the cuticle and the proximal and lateral nail folds.
Water and irritant avoidance is the hallmark of treatment of chronic paronychia.
Paronychia means inflammation of the nail apparatus. Acute paronychias are infections of the periungual tissues, usually presenting with an acutely painful, purulent infection. Chronic paronychia represents barrier damage to the protective nail tissues, including the cuticle and the proximal and lateral nail folds. The altered nail barrier predisposes the nail to irritant dermatitis, most importantly from water, soap, chemicals, and microbes. Avoidance of such irritants is the hallmark of treatment.
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)
- 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
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)
- biopsy of skin/bone
- Herpetic whitlow
- Arthropod bite or sting
- Traumatic injury
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