Paronychia - Symptoms and Treatment

Paronychia disease is an infection of the inflammation skin and soft tissue infections that surrounds a toenail or fingernail. It can start suddenly (acute paronychia) or gradually (chronic paronychia). There are two different types of paronychia, acute and chronic depending on the amount of time the infection has been present. The etiology, infectious agent, and treatment are usually different for each form, and the 2 forms are often considered separate entities. Acute paronychia develops over a few hours when a nail fold becomes painful, red and swollen. It is the most common hand infection in the United State.

Symptoms of Paronychia

A small collection of pus forms under the skin next to the nail, or underneath the nail itself.The area around the nail is tender, red and mildly swollen the cuticle is missing; and the skin around the nail feels moist or "boggy." Often, only one nail is affected. Acute paronychia starts as a red, warm, painful swelling of the skin around the nail. In chronic paronychia, the redness and tenderness are less noticeable than the acute infection. The nail may have a green discoloration due to Pseudomonas infection. It mainly occurs in people who have constantly wet hands, such as hairdressers, nurses, bartenders and housewives.

Causes of Paronychia

The causes of acute Paronychia and chronic Paronychia are defind follow :

• Acute paronychia usually results from a traumatic event, however minor, that breaks down the physical barrier between the nail bed and the nail; this disruption allows the infiltration of infectious organisms.
• Acute paronychia can result from seemingly innocuous conditions, such as hangnails, or from activities, such as nail biting, finger sucking, manicuring, or artificial nail placement.
• Staphylococcus aureus is the most common infecting organism. Organisms, such as Streptococcus and Pseudomonas species, gram-negative bacteria, and anaerobic bacteria are other causative organisms.
• Acute (and chronic) paronychia may also occur as a manifestation of other diseases, such as pemphigus vulgaris.
• Chronic paronychia is primarily caused by the yeast fungus Candida albicans .
• Other rare causes of chronic paronychia include bacterial, mycobacterial, or viral infection; metastatic cancer; subungual melanoma; and squamous cell carcinoma.
• Chronic paronychia most often occurs in persons whose hands are repeatedly exposed to moist environments or in those who have prolonged and repeated contact with irritants such as mild acids, mild alkalis, or other chemicals

Treatment of Paronychia

The treatment of choice depends on the extent of the infection. the treatment list of acute Paronychiaare below:

• Warm water soaks of the affected finger 3-4 times per day until symptoms resolve are helpful.
• Oral antibiotics with gram-positive coverage against S aureus, such as amoxicillin and clavulanic acid (Augmentin) or clindamycin (Cleocin), are usually administered concomitantly with warm water soaks.
• Cleocin and Augmentin also have anaerobic activity; therefore, they are useful in treating patients with paronychia due to oral anaerobes contracted through nail biting or finger sucking.
• Cleocin should be used instead of Augmentin in patients who are allergic to penicillin.
• If the paronychia does not resolve or if it progresses to an abscess, it should be drained promptly.

Treatment of chronic Paronychia are

• The initial treatment of chronic paronychia consists of the avoidance of inciting factors such as exposure to moist environments or skin irritants. Keeping the affected lesion dry is essential for proper recovery. Choice of footgear may also be considered.
• Any manipulation of the nail, such as manicuring, finger sucking, or attempting to incise and drain the lesion, should be avoided; these manipulations may lead to secondary bacterial infections. Mild cases of chronic paronychia may be treated with warm soaks.
• The initial medical treatment consists of the application of topical antifungal agents. Topical miconazole may be used as the initial agent. Oral ketoconazole or fluconazole may be added in more severe cases.
• Patients with diabetes and those who are immunocompromised need more aggressive treatment because the response to therapy is slower in these patients than in others.
• In cases induced by retinoids or protease inhibitors, the paronychia usually resolves if the medication is discontinued.

Prevention Tips

• Keep your hands and feet dry and clean.
• Wear rubber gloves with an absorbent cotton lining if your hands are exposed routinely to water or harsh chemicals.
• Be gentle when you manicure your nails. Avoid cutting your cuticles or pushing them back.
• Avoid biting your nails and picking at the skin around your nails.
• If you have diabetes, keep your blood sugar levels within a normal range by following your diet and taking your medications.