Paronychia

What is Paronychia?

Paronychia is a type of infection that affects the base and sides of the fingernails and toenails, including the area around the root of the nail. This condition can occur on its own, or as a result of injury or handling of the nail. Paronychia is one of the most common hand infections.

Basically, this infection happens when the protective barrier that exists between the nail and the fold of the skin around it is broken. This allows bacteria to get in, making the area prone to infection. Acute paronychia, a severe and sudden form of the condition, usually affects only one nail. However, if caused by certain drugs, it can involve multiple nails.

What Causes Paronychia?

Paronychia is a condition that affects your nails and it’s categorized based on how it looks and feels:

* Acute paronychia – This type lasts less than six weeks and is often painful and filled with pus. It’s commonly caused by a bacterial infection, particularly by bacteria called staphylococci.
* Chronic paronychia – This type is usually caused by physical or chemical damage, and sometimes by an infection such as a fungal infection, particularly Candida species. Jobs where your hands get wet a lot (like being a dishwasher, bartender, or housekeeper), certain medicines, and a weak immune system (like having diabetes, HIV, or cancer) can increase your risk.

Paronychia can also be categorized based on what causes it:

* Bacterial, usually from staphylococci
* Viral, often from the Herpes simplex virus
* Fungal, typically from Candida species

There are also non-infectious causes of paronychia, such as contact with irritants, too much moisture, and medication reactions.

Risk Factors and Frequency for Paronychia

Paronychia, a condition often seen in people who use their hands or feet in damp conditions for long periods, is more common in women. In fact, it affects three times as many women as men. The highest risk group for this condition is middle-aged women.

• Paronychia is three times more common in women than in men.
• It is often seen in individuals who work in jobs that require their hands or feet to be in water for an extended time, such as dishwashers.
• Middle-aged women have the highest risk of getting this infection.

Signs and Symptoms of Paronychia

Paronychia is an infection that causes redness, swelling, and pain around the nail, typically appearing within a few days of infection. Some factors like recent injury, other infections, abnormal nail structure, and inflammatory diseases can contribute to this condition. Certain professions like homemakers, bartenders, and dishwashers are more likely to develop chronic paronychia due to frequent handwashing or exposure to moisture. It’s also essential to consider past illnesses such as diabetes and HIV, as well as the patient’s current medications when diagnosing chronic paronychia.

During an examination for acute paronychia, the doctor will look for red, swollen, and tender skin around the nail. If there is a pus-filled abscess, it can be detected by applying pressure to the area and looking for a larger blanched (whitened) area. If present, the abscess may need to be drained. Chronic paronychia also results in red and swollen nail folds, but the presence of an abscess is less common. The nail may appear spongy, with a thicker and discolored nail plate. Other common signs of chronic paronychia include:

• Retraction of the proximal nail fold (skin immediately surrounding the nail)
• Changes in nail shape or texture (nail dystrophy)
• Loss of cuticle

Testing for Paronychia

To figure out if you have a condition called paronychia, your doctor will ask you about your medical history and perform a physical exam. Paronychia causes the skin around your nail to become swollen and painful. There are no laboratory tests or imaging scans that can confirm this condition, so your doctor will rely on these symptoms to make a diagnosis. If your doctor suspects there’s an abscess (a pocket of pus), he or she may apply pressure to the tender area. This test helps your doctor to find the abscess and decide the best way to treat your infection.

Treatment Options for Paronychia

Paronychia is an infection of the skin around the nails. It can be treated in various ways including drainage of any pus, or using antibiotics.

If there is swelling and redness without a clear pocket of pus, treatment can include soaking the affected finger or toe in warm water or antiseptic solutions like chlorhexidine and povidone-iodine. This should be done for 10 to 15 minutes, several times a day.

Alongside this, antibiotics that can fight off Staphylococcus aureus, a common bacteria that causes skin infections, might be used. These antibiotics can either be applied directly to the skin (topical) or be taken in tablet form (oral). There isn’t a strong consensus on which is better and the choice may be based on your doctor’s preference and experience.

More severe cases of paronychia that do not improve with topical treatments may require oral antibiotics. Also, if the infection could have come from the mouth, such as by nail biting, more specialized antibiotics that can fight off mouth bacteria may be used.

If the patient has been recently hospitalized, has a history of certain diseases like HIV/AIDS, or lives in a long-term care facility, they may need antibiotics that can fight off a tougher type of bacteria known as MRSA.

If there is a clear pocket of pus, or abscess, it will need to be drained. This can be done by making a small cut in the infected area with a scalpel. Local anesthesia, which numbs the area to prevent discomfort, is typically used. Once the pus is drained, the area is cleaned out with a salt water solution, and, if needed, packed with gauze to keep it open and allow for more drainage.

If the infection has spread underneath the nail or is associated with an ingrown toenail, removal of a part or the entire nail may be necessary. Soaking the area in warm water should be continued after the drainage procedure to encourage ongoing drainage and prevent secondary infection.

Follow-up is important 24 to 48 hours after the drainage to ensure the infection is not growing worse.

In chronic paronychia, which lasts over several weeks, the patient should avoid injuring their hands as much as possible. Wearing gloves is recommended for people who work with their hands.

Because chronic paronychia is often caused by a fungus, antifungal medications may be used for treatment. If an underlying condition like psoriasis or an ingrown nail is also present, it should be treated as well.

In difficult-to-treat chronic cases, other causes, such as skin cancer, should be investigated.

What else can Paronychia be?

When diagnosing paronychia, which is an infection of the skin around the fingernails or toenails, doctors consider several other conditions that might have similar symptoms. These include:

• Cellulitis: This is a skin infection causing redness and swelling but no fluid buildup. It is usually treated with oral antibiotics.
• Felon: This is an infection under the skin of the fingertip. The affected area can become warm, red, and painful due to the built-up pressure. Treatment typically involves an incision and fluid drainage.
• Herpetic whitlow: This condition is a viral infection from the herpes simplex virus. It causes a burning, itching feeling in the finger, and then blisters and redness develop. Misdiagnosing this as an infected skin condition can lead to complications.
• Onychomycosis: This is a fungal infection of the nail causing a white or yellow discoloration. It’s often hard to treat and usually requires oral antibiotics, as topical treatments may not be effective.
• Nail Psoriasis: This form of psoriasis can affect the fingernails and toenails, leading to nail thickening and other abnormalities, such as small pits in the nails, ridges, irregular contour, and the nail lifting from the nail bed.
• Squamous cell carcinoma: This is a type of skin cancer that can also affect the nail bed. This rare under-the-nail tumor can sometimes be misdiagnosed as chronic paronychia.

It is important for healthcare professionals to accurately identify the cause of a patient’s symptoms to ensure appropriate treatment.

What to expect with Paronychia

Paronychia, also known as a skin infection around a fingernail or toenail, typically has a positive outcome. Acute paronychia, a sudden and short-term condition, usually clears up within a few days and it’s rare for it to come back in people who are generally healthy.

However, chronic paronychia, a long-term condition, can continue for several months or more and it may come back in individuals who are more susceptible to this kind of infection.

Possible Complications When Diagnosed with Paronychia

Acute paronychia is a serious hand infection that can progress and affect underlying tendons if not treated promptly. Depending on how severe the infection is, it may be necessary for a hand surgeon to intervene, sometimes requiring procedures like debridement (removal of damaged tissue), washout (cleaning of the wound), or even amputation.

Chronic paronychia leads to a major complication known as nail dystrophy. Nail dystrophy is principally marked by brittle and deformed nail plates, a condition commonly seen in those suffering from chronic paronychia. Nail discoloration is another frequent outcome of this persistent condition.

Complications of Paronychia:

• Severe hand infection
• Spread to underlying tendons
• Necessary surgical interventions (e.g., debridement, washout, amputation)
• Nail dystrophy (brittle, distorted nails)
• Nail discoloration

Preventing Paronychia

Patients should ensure their hands are kept dry and warm. It is advised to wear gloves whenever your hands may contact water, chemicals, or anything that could irritate the skin. It’s best to refrain from biting your nails, manicuring the skin around your nails, using nail polish, or applying false nails until you have fully recovered.