paronychia

Paronychia
Classification and external resources
ICD-10	L03.0
ICD-9	681.02, 681.11
DiseasesDB	9663
MedlinePlus	001444
eMedicine	derm/798
MeSH	D010304

The nail disease paronychia [par'onikeea] (commonly misidentified as a synonym for whitlow or felon) is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail. The infection can start suddenly (acute paronychia) or gradually (chronic paronychia).^[1][2]

Types

Paronychia may be divided as follows:^[3]

• Acute paronychia
• Chronic paronychia

Alternatively, paronychia may be divided as follows:^[4]

• Candidal paronychia
• Pyogenic paronychia

Description

Dr. Rob Hicks writes on the BBC website:

The cuticle acts as a protective seal but if it's damaged in any way bacteria can enter the skin and cause infection. These infections can be extremely painful as the skin becomes inflamed, hot, red and throbs continually.^[5]

Pus is usually present, along with gradual thickening and browning discoloration of the nail plate.

Hicks continues:

If a large amount of pus has collected, then it may be necessary to see your doctor who will lance open infection in the skin to release it.^[5][6]

Acute paronychia is usually caused by bacteria. This is often treated with antibiotics, sometimes as a cream, other times orally. Chronic paronychia is most often caused by a yeast infection of the soft tissues around the nail but can also be traced to a bacterial infection. If the infection goes on and on then a fungal infection is often the cause and this needs anti-fungal cream or paint to treat it.^[5]

Hicks writes further about the causes:

Whitlows are common, especially for people who have to repeatedly wash their hands. Excess water weakens the seal, while soaps and detergents remove the protective skin oils leaving the skin dry and more liable to split. Most often, trauma to the cuticle allows infection in. Biting or picking at the cuticle, damage through work and overenthusiastic manicuring are the usual culprits. If someone has a cold sore and puts their finger in their mouth then a herpes infection whitlow may appear.^[5]

Individuals who work with their hands in water, such as health care workers and food processors, are quite prone to the fungal type of infection.

Paronychia of the big toe

Herpes whitlows are frequently found among dentists and dental hygienists.^[7] Prosector's paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specimens for dissection. Paronychia around the entire nail is sometimes referred to as runaround paronychia.

Painful paronychia in association with a scaly, erythematous, keratotic rash (papules and plaques) of the ears, nose, fingers, and toes, may be indicative of acrokeratosis paraneoplastica, which is associated with squamous cell carcinoma of the larynx.^[8]

Paronychia must also be thought of as a potential drug induced process and this must be ruled out. Furthermore, it may be representative of systemic disease such as pemphigus.^[9]

Treatment

Oral fluconazole may be used to treat fungal paronychia, whereas erythromycin or cephalexin may be used to treat bacterial paronychia.

• it is recommended to soak the finger in hot water 2-3 time daily and to drain the pus

• in chronic cases you can use topical antifungal like ketoconazole cream. A mild topical steroid like hydrocortisone can be applied to relieve the pain and inflammation

References

1. ^ Rigopoulos D, Larios G, Gregoriou S, Alevizos A (February 2008). "Acute and chronic paronychia". Am Fam Physician 77 (3): 339–46. PMID 18297959. 
2. ^ Rockwell PG (March 2001). "Acute and chronic paronychia". Am Fam Physician 63 (6): 1113–6. PMID 11277548. 
3. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
4. ^ Freedberg, et. al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
5. ^ ^{a b c d} "Doctor's advice Q: Whitlow (paronychia)". bbc.co.uk. http://www.bbc.co.uk/health/ask_the_doctor/whitlow.shtml. Retrieved 2008-05-10. 
6. ^ Jacobs, J.R. (2006 June-July). "Pathophysiology and Management of Paronychia". collegehealth-e. http://www.collegehealth-e.org/3/n04.htm. 
7. ^ Lewis MA (2004). "Herpes simplex virus: an occupational hazard in dentistry". Int Dent J 54 (2): 103–11. doi:10.2956/indj.2004.54.2.103 (inactive 2008-08-12). PMID 15119801. http://www.atypon-link.com/FDI/doi/abs/10.2956/indj.2004.54.2.103. 
8. ^ Karen Allen, MD (2005-08-17). "eMedicine - Acrokeratosis Neoplastica". http://www.emedicine.com/derm/topic6.htm. 
9. ^ http://dermatology-s10.cdlib.org/1507/reviews/nail_pemphigus/rashid.html

External links

• "Paronychia Nail Infection". Dermatologic Disease Database. American Osteopathic College of Dermatology. http://www.aocd.org/skin/dermatologic_diseases/paronychia_nail_in.html. Retrieved 2006-07-12. 
• "What Is The Best Way To Treat Paronychias?, Roundtable discussion in Podiatry Today, Volume 15 - Issue 3, March 2002, pp. 58-60.