Skin & Soft Tissue: Acute Paronychia

Definition

• Definition: Acute Inflammation of the Proximal & Lateral Nail Folds
  • May Have Associated Abscess
• Most Common in Finger Nails Although Also Seen in Toenails
• Most Common Organism: Staphylococcus aureus

Risk Factors

• Most Common Risk Factor: Minor Skin Breakdown (Occupational Exposure Common)
• Manicures
• Artificial Nails
• Nail Biting
• Thumb-Sucking
• Hangnails
• Ingrown Toenails

Presentation

• Erythema & Swelling of the Proximal & Lateral Nail Folds
• May See a Fluctuant Abscess

Treatment

• Inflammation without Abscess: Warm Compress & Topical Antibiotics
  • If Fails: Oral Antibiotics (Dicloxacillin or Cephalexin)
• Abscess: Incision & Drainage
  • Incision: Lift the Nail Bed at the Lateral Nail Fold & Make a Longitudinal Lateral Incision Parallel to the Nail
  • Consider Oral Antibiotics if Severe or Immunosuppressed

Chronic Paronychia

• Definition: Inflammation of the Nail Folds Lasting ≥ 6 Weeks
• Most Common in Patients with Chronically Wet Hands (Dishwashers, Bartenders, Housekeepers)
• Chronic Inflammation Can Cause Rounding of the Nail Folds to Expose the Nail Groove & Lose the Protective Seal
• Candida May Be Present but Role Uncertain
• Treatment: Topical Steroids
  • Addition of Antifungals May Assist in Management
  • Consider Nail Removal If Steroids Fails