Paronychia

Last reviewed by Dr.Mary on August 7th, 2018.

What is Paronychia?

This is an infection that develops on the edge of the toenail or fingernail. It is one of the most common hand infections and when left untreated can grow to a much more severe infection of the total finger or toe. This complaint is seen very often in children because of biting their nails. Paronychia is divided into two types acute paronychia as well as chronic paronychia, dependent on the total interval that the infection has existed.

Paronychia Symptoms

This condition or infection can begin as swelling and redness surrounding the nail. It is more frequently very sore or tender to the touch and sometimes, can be a green-yellow color which points to a pool of pus forming beneath the skin and that an abscess is forming.

The most frequent symptoms or signs are:

Redness
Swelling
Tenderness and pain to touch
Pus collection

An individual should call their physician if this redness starts to extend past the skin surrounding the fingernail or to the finger pad. This indicates an infection could be developing into a serious finger problem in the deeper tissues of the fingertip, known as a felon.

A call to the physician should also be made if an abscess starts forming. Abscesses need draining by a medical professional. Opening up or incising abscesses to drain the pus from the wound should never be done in a casual matter at home.

At the very first symptom that pus is collecting, the individual should pursue medical care for potential drainage. If there are signs of swelling as well as redness extending down the finger or the individual is not able to move the joints of the finger that is affected, it is important to go to the hospital’s emergency room as quickly as possible. This situation may or may not be linked with chills or fever, indicative of a serious infection.

Paronychia Causes

Both acute as well as chronic infections start when there has been a break in the skin or the epidermis. An acute contagion is mostly linked to an injury to the skin for instance an ingrown nail, hangnail, or nail biting. This break in the skin leaves an opening for bacteria to invade. The most frequent bacteria that causes acute infections is usually Staphylococcus aureus. But there are other bacteria that less frequently cause infections and are commonly of the Streptococcus species as well as Pseudomonas species. Chronic infections are normally linked with irritation that is repeated for example exposure to water as well as detergents. Many infections that are chronic are started by Candida albicans as well as other fungi.

Acute Paronychia

Acute infections begin as warm, swollen, painful, as well as redness of skin surrounding the finger or toe nail. This can progress on to the development of pus which can separate the nail and the skin. Lymphatic nodes located in the armpit or elbow can swell.

Chronic Paronychia

With chronic infection, the tenderness and the redness are much less obvious than infections that are acute. The skin surrounding the nail may get boggy. Also the nail can have a greenish coloration because of Pseudomonas infection.

Diagnosis

This is diagnosed mostly based on the clinical symptoms. Often when there is the involvement of pus, a culture can be obtained to define the type of bacteria involved. This isn’t essential since the bacteria are usually associated with a Streptococcus or Staphylococcus species. The infection of chronic paronychia is much harder to diagnose. A KOH test of a smear from the fold of the nail can often expose a fungus.

Paronychia Treatment

Soaks that are warm may be done three or four times each day with acute infections in order to encourage drainage as well as diminish some pain or tenderness. Many acute cases need to be cured with antibiotics for example dicloxacillin or cephalexin. Antibiotics that are topical or ointments that are anti-bacterial do not treat effectively paronychia infections. When there is an abscess or pus involvement, the infection will require an incision as well as draining. Very rarely, a part of the finger or toe nail may also require detachment.

Chronic infections are treated with antifungal topical drugs such as ketoconazole cream. A milder topical steroid such as hydrocortisone can additionally be used with the antifungal drug in order to reduce any inflammation. Steroids should not be used alone with a chronic infection.

Special Cases

Individuals with any of the following problems are inclined to develop infections that are more extensive and should be treated with a lengthy sequence of antibiotics.