Do you have ever experienced painful inflammation of your nail fold with or without abscess formation? This condition is called Paronychia, which is the localised inflammation of the skin immediately surrounding the fingernail or toenail. ( rare in toes)
Acute and chronic paronychia
It is classified into acute and chronic according to the presentation and duration. Which presents with pain, oedema, and erythema with possible fluid collection within 6 weeks of onset are called acute paronychia. Usually it is associated with abscess formation.
In chronic paronychia, patient presets with symptoms like erythema, pain and oedema but usually without purulent fluid collection more than 6 weeks and associated with nail plate changes like discolouration, nail plate destruction and deformities. Repeated physical trauma or irritation to the cuticle of the nail of the results in recurrent inflammation, with persistent oedema, induration, and fibrosis of the proximal and lateral nail folds. As a result in loss of the the seal at the lateral nail fold/cuticle–nail plate interface. Therefore moisture will retain and results in fungi infections, further inflammation and tissue fibrosis.
Acute paronychia, most of the times develops following acute minor trauma to fail fold , but in chronic stage it is following repeated micro-trauma, exposure to skin irritants or allergens and nay be following repeated episodes of acute paronychia. The causative organism for acute paronychia are most of the time bacteria while fungus or chemical irritants are responsible in chronic stage.
Diagnosis of the condition is done by clinical history and examination. If it is associated with purulent fluid collection fluid wound be sent for cultures to exclude type of organisms called MRSA, which are resistant for most of the available antibiotics.
The goals of the treatment
- Decrease pain
- Eradicate infection and reduce inflammation
- Prevent complications and recurrence
Treatment for Paronychia
Topical antibiotics or application of antibiotic creams are the first line treatment for acute stage. If there is abscess formation, it should be drained as a minor surgical procedure. If the condition is associated with ingrowing toe nail( would be discussed in a separate article) nail plate excision should be done after the acute inflammation is settled.
Acute paronychia would response well to these treatment unless the patient is immunocompromised. Usually this improves within a few days to one week.
Oral antibiotics are reserved for patients who are immunocompromised, those with diabetes or severe infection, and patients who do not respond to antibiotic treatment with incision and drainage.
As the chronic paronychia is multi-factorial, the contributing factors should be treated. Therefore avoidance of contact with irritants, application of corticosteroids and anti-fungal cream are the main stay of treatment.
Chronic paronychia responds to the treatment much more slowly and often requires several months of treatment for complete symptom resolution.
Common complications of acute paronychia are osteomyelitis, subungual abscess and felon while chronic paronychia would complicate with recurrent episodes, fungal and secondary bacteria infections and nail changes and destruction.
Prevention of Paronychia
For the prevention of acute and chronic paronychia proper nail trimming, prevention of traumatic behaviours like trimming cuticles, wearing artificial nails, nail biting and finger sucking. Patients with diabetes should maintain good glycemic control. Those who have chronic condition should keep the hands clean and dry and nails short. In addition to that wearing gloves when handling irritant ( with inner cotton lining) and dry and applying moisturising lotion after hand washing would be beneficial.
Who should you consult
If you are having feature of paronychia, you should consult a general surgeon or attend a general surgical clinic. If you have a chronic skin irritation or allergic condition better to consult a dermatology clinic.