Randy Jacobs, M.D. Patient Education

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What Is It?


Paronychia is an inflammatory reaction involving the folds of skin surrounding the fingernail. Paronychia may be acute or chronic, purulent, tender, and painful with swelling of tissues around the nail. Usually, Paronychia is a result of trauma from moisture-induced maceration of nail folds resulting from frequent water exposure. Paronychia starts because the moist nail grooves become secondarily invaded by bacteria or yeast. In paronychia, the most commonly found bacteria are staphylococci, pseudomonas aeruginosa, and streptococcus. Candida albicans is the most common yeast organism found. Candida is suspected if the proximal nail fold is involved, while Staph is suspected if the lateral areas are involved.


Acute paronychia


Acute paronychia develops over a few hours when a nail fold becomes painful, red and swollen. Sometimes yellow pus appears under the cuticle. In some cases fever and painful glands under the arms accompany acute paronychia.  It is usually due to Staphylococcus aureus, a bacterial infection treated with oral antibiotics. Sometimes an abscess forms and has to be lanced.  Acute paronychia usually clears completely in a few days, and rarely recurs.


Chronic paronychia


Chronic paronychia is a gradual process and much more difficult to get rid of. It may start in one nail fold but often spreads to several others. Each affected nail fold is swollen and lifted off the nail plate. It may be red and tender from time to time, and sometimes a little pus (white, yellow, or green) can be expressed from under the cuticle. The nail plate becomes distorted and ridged as it grows. It may become yellow or green and brittle. After recovery, it takes up to a year for the nails to grow back to normal. Chronic paronychia is due to several different micro-organisms. Often a mixture of yeasts and bacteria are present, particularly candida species and Gram negative bacilli. The inflammation results in debris, which builds up, encouraging more infection. It mainly occurs in people who have constantly wet hands, such as dairy farmers, fishermen, bar tenders and housewives. It is more likely to occur, and more difficult to clear up, in those with poor circulation, especially during the winter months.


How Is Paronychia Treated and Prevented?


Preventive measures are important for anyone who uses their hands in water. Preventive measures consist of cotton lined rubber gloves to keep the hands dry and warm. Avoid wet work, or use totally waterproof gloves. Keep your hands clean. Wash thoroughly after dirty work with soap and water, and rinse off. Dry carefully. Don't let the skin dry out and crack. Prevent drying by applying a moisturizing hand cream frequently. Apply antimicrobial lotion regularly twice daily to the nail fold. A suitable preparation is: Polysporin lotion or spray. Topical gentimicin solution may be prescribed. Dr. Jacobs may recommend a course of an oral anti-yeast agent or anti bacterial antibiotic. Also, Dr. Jacobs may order an x-ray to rule out a bone infection in severe cases. It often takes months to clear paronychia, and it can recur in predisposed individuals if not prevented.