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
- medications (chronic)
- 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
acute paronychia
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.
Differentials
- Herpetic whitlow
- Arthropod bite or sting
- Traumatic injury
More DifferentialsPatient information
Dermatitis
Fungal nail infections
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