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PARONYCHIA FINGER

Introduction

Paronychia is a bacterial infection of the nail fold. In acute paronychia, the cultured bacterium is usually Staphylococcus aureus. It is typically caused by nail biting and manicures. Chronic paronychia is a different disease process, and the cultured bacterium is usually Candida albicans. Chronic paronychia affects individuals whose hands are exposed to water or wet environments for long periods of time, such as kitchen and laundry workers, bartenders and swimmers.

Related Anatomy

  • Nail fold
  • Nail plate
  • Cuticle

Incidence and Related Conditions

Paronychia accounts for 35% of infections of the hand.

  • Paronychia is more common in women than in men, with a female-to-male ratio of 3:1.

Differential Diagnosis

  • Candidiasis
  • Felon finger
  • Herpetic hitlow
  • Glomus tumor
  • Malignant melanoma
Clinical Presentation Photos and Related Diagrams
  • Early paronychia with previous nail damage (Hover over right edge to see more images)
    Early paronychia with previous nail damage (Hover over right edge to see more images)
  • Late paronychia with dorsal blister from swelling
    Late paronychia with dorsal blister from swelling
  • paronychia index
    paronychia index
  • Gouty tophus not paronychia
    Gouty tophus not paronychia
  • Heretic Whitlow (viral infection)
    Heretic Whitlow (viral infection)
Symptoms
Redness, swelling and pain at the base of the fingernail
Sealing nail fold with nail polish or injury to nail fold
Typical History

The patient is usually complaining of a warm,red and painful area at the base of the fingernail. The patient may have a history of injury or that she/he recently had nails done. Fever is rare but can occur. There maybe purlulent drainage from under the nail fold.

Positive Tests, Exams or Signs
Tenderness
Work-up Options
Sonographic studies - Ultrasound
Laboratory tests - blood tests
Radiology studies - X-ray
Laboratory tests - culture
Images (X-Ray, MRI, etc.)
Treatment Options
Conservative: 
  • Oral antibiotics and soaks
  • IV antibiotics 
  • Topical steroids
  • Topical and systemic antifungal
  • Combination of topical steroid and antifungal
Operative: 

 

Treatment Photos and Diagrams
  • Paronychia Long Finger (Hover over right edge to see more images)
    Paronychia Long Finger (Hover over right edge to see more images)
  • Paronychia Long Finger Treatment
    Paronychia Long Finger Treatment
Complications
  • Secondary Felon (pulp Abcess)
  • Recurrences
  • Nail deformities
  • Osteomyelitis
Outcomes
  • Topical steroids are more effective than are systemic antifungals.
  • In one study, of patients who had en bloc excision of PNF with nail avulsion, 70% were cured; of those who had en bloc excision of PNF without nail avulsion, 41% were cured.1
Key Educational Points
  • Presence of vesicles suggests herpetic whitlow
  • Green coloration may suggest Pseudomonas
  • Nail plate hypertrophy may suggest fungal infection
  • Severe pain with nail plate elevation, bluish discoloration and blurring of the lunula suggests glomus tumor
  • A common culture in the chronic paronychia is C. Albicans.
  • Chronic paronychia is treated by eponychial marsupialization.
  • Herpetic Whitlow is a viral infection that requires treatment with antiviral medications and should NOT be treated with surgical incision and drainage.
  • Incision and drainage of a herpetic whitlow can cause the simple often self-limited viral infection of a digit to be complicated by an encephalitis. 
Practice and CME
References

Cited

  1. Grover C, Bansal S, Nanda S. En bloc Excision of proximal nail fold for treatment of chronic paronychia. Dermatol Surg 2006;32:393-8. PMID: 16640685

New Articles

  1. Allouni A, Yousif A, Akhtar S. Chronic paronychia in a hairdresser. Occup Med (Lond) 2014;64(6):468-9. PMID: 24985481
  2. Pabari A, Iyer S, Khoo CT. Swiss roll technique for treatment of paronychia. Tech Hand Up Extrem Surg 2011;15(2):75-7. PMID: 21606775

Reviews

  1. Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg 2014;22(3):165-74. PMID: 24603826
  2. Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol 2014;59(1):15-20. PMID: 24470654

Classics

  1. Hayward R. Chronic paronychia. Can Med Assoc J 1962;86(6):292. PMID: 20327031
  2. Lowden TG. Paronychia. Lancet 1953;1(6751):118-21. PMID: 13011975