Overview

Paronychia is a common infection of the skin around the fingernails or toenails, characterized by redness, swelling, and pain in the affected area. It occurs when bacteria, fungi, or yeast invade the skin near the nail, usually through a break or injury. Paronychia can be classified into two main types: acute and chronic. Acute paronychia develops suddenly and is typically caused by bacterial infections, while chronic paronychia persists for more than six weeks and is often associated with fungal infections or prolonged irritation. Although generally not life-threatening, paronychia can cause significant discomfort and, if left untreated, may lead to complications such as abscess formation or nail deformities.

Causes

The causes of paronychia vary depending on whether it is acute or chronic:

• Acute Paronychia: This type is most commonly caused by bacterial infections, especially Staphylococcus aureus and Streptococcus species. The infection typically occurs after minor trauma to the nail area, such as nail biting, hangnails, aggressive manicuring, or finger sucking.
• Chronic Paronychia: Chronic cases are usually due to fungal infections, particularly Candida species. Contributing factors include frequent exposure to water or chemicals, which leads to constant irritation and breakdown of the nail fold barrier. People who work in wet environments, such as dishwashers or healthcare workers, are at higher risk.

Symptoms

The symptoms of paronychia can vary depending on the type and severity of the infection:

• Redness and swelling: The skin around the nail becomes red, swollen, and tender.
• Pain: Patients often experience throbbing or sharp pain near the affected nail.
• Pus formation: In acute paronychia, pus may collect under the skin, forming an abscess that may drain spontaneously.
• Warmth: The infected area often feels warm to the touch.
• Discoloration and nail changes: In chronic paronychia, the nail may become discolored, ridged, or even detached from the nail bed.
• Recurrent symptoms: Chronic cases may cause repeated flare-ups, with periods of symptom relief followed by worsening.

Diagnosis

Diagnosing paronychia is primarily clinical, based on the appearance of the affected area and patient history. Healthcare providers may perform the following evaluations:

• Physical examination: Inspection of the nail and surrounding tissue to assess the presence of redness, swelling, and discharge.
• Medical history: Inquiry about recent trauma, nail-biting habits, occupational exposures, or underlying health conditions.
• Cultures: In certain cases, especially chronic paronychia, a sample of the discharge or tissue may be sent for bacterial or fungal culture to identify the causative organism and guide treatment.
• Differential diagnosis: Conditions such as herpetic whitlow, nail psoriasis, or eczema may resemble paronychia and should be considered during diagnosis.

Treatment

Treatment of paronychia depends on the duration, severity, and underlying cause of the infection:

• Acute Paronychia:
  • Mild cases: Soaking the affected finger or toe in warm water several times a day can help reduce inflammation and promote drainage.
  • Antibiotics: Oral or topical antibiotics are prescribed if a bacterial infection is suspected.
  • Incision and drainage: If there is an abscess, a healthcare provider may need to drain the pus surgically.
• Chronic Paronychia:
  • Avoiding irritants: Keeping the affected area dry and protected from moisture and irritants is crucial.
  • Antifungal treatments: Topical antifungal creams or oral antifungal medications may be prescribed.
  • Anti-inflammatory therapy: Topical corticosteroids may be used to reduce inflammation in chronic cases.

Prognosis

With proper treatment, the prognosis for paronychia is generally excellent, especially for acute cases. Most individuals recover completely without long-term effects once the infection is treated. However, in chronic cases, the prognosis depends on adherence to preventive measures and effective management of the underlying cause. Chronic paronychia can lead to recurrent infections, persistent nail deformities, and in some cases, nail loss. Early recognition, timely treatment, and preventive care play crucial roles in minimizing complications and ensuring a full recovery.