Paronychia
SUMMARY: Overview of paronychia aka angry fingernails and toenails due to inflammation.
Definition
Inflammation of the folds of tissue surrounding the nail of a toe or finger.
Fact Sheet
Paronychia Fact Sheet [PDF]
Predisposing factors
Overzealous manicuring
Nail biting, picking, sucking
Ingrown nail
Diabetes Mellitus
Occupations where your hands are constantly immersed in water
Medication side effects
Acute Paronychia (<6 weeks)
Causes
Infection by skin flora (staph aureus, strep pyogenes)
Drugs (chemotherapy, immunotherapy, anti-virals)
Trauma (Splinter, nail-biting, picking, manicures)
Presentation
Acute paronychia is characterised by the rapid onset of painful redness and swelling of the nail folds. Often happens two to five days after minor local trauma. Usually, only involves one finger.
Differential Diagnoses
Felon (infection of the finger pulp space, not nail folds)
Herpes simplex infection
Acrodermatitis continua of Hallopeau (form of pustular psoriasis)
Onychomycosis (fungal infection)
Green nail syndrome (bacterial infection with Pseudomonas Aeruginosa)
Treatment of Acute Paronychia
If there is an associated abscess
Incision and drainage with purulent discharge cultured
Reassess in 7 days
In ongoing inflammation then systemic antibiotic therapy (Flucloxacillin or Cephalexin)
If there is no abscess
Warm water or antiseptic soaks for 10 to 15 minutes (eg, chlorhexidine, povidone-iodine)
Topical antibiotics for 3 times daily (Mupirocin 2%)
Reassess in 7 days
If ongoing inflammation then systemic antibiotic therapy
Long-term prevention
Avoid aggressive manicuring
Avoid nail biting and picking at hangnails
Chronic Paronychia (>6 weeks)
Causes
Environment irritations and allergens (e.g. wet work, foods, chemicals)
Inflammatory skin conditions such as dermatitis and psoriasis
Secondary fungal or bacterial infection can occur
Clinical Presentation
There is usually swelling and redness of the nail folds with loss of cuticle. Nail changes can occur such as ridging, Beau lines, and discolouration.
Differential Diagnosis
Squamous cell carcinoma
Can be an external manifestation of internal cancers
Psoriasis
Reiter’s Syndrome
Treatment
Avoid environmental triggers
Keep hands as dry as possible
Use gloves for any wet work
Medication
First-line therapy is topical corticosteroids
High potency steroid (e.g. Diprosone, Advantan) used once or twice daily for two to four weeks