Paronychia

Question 1

What is paronychia?

Answer 1

1. Infection of the perionychium (skin overhanging the side of the nail)
   *MC hand infection in the US
   *common in children (finger biting/sucking)

Question 2

What is the etiology behind acute paronychia?

Answer 2

1. Beings with a break in the epidermis
   *associated with trauma to the skin (hangnail, ingrown nail, or nail biting)
   *bacterial Staph aureus

Question 3

What is the etiology behind a chronic paronychia

Answer 3

Associated with repeated irritation
*exposure to detergents and water
*typically yeast of fungal
*candida albicans or other fungi MC

Question 4

What is the pathophysiology of acute paronychia

Answer 4

1. The cuticle acts as a protective seal, if it is damaged, the pathogens are able to enter
2. Acute develops over a few hours when a nail fold becomes painful, red, and swollen

Question 5

What is the pathophysiology of chronic paronychia

Answer 5

1. The cuticle acts as a protective seal, if it is damaged, the pathogens are able to enter
2. Chronic is a gradual process, may start in one nail fold and spread to others

Question 6

What are the risk factors of paronychia

Answer 6

1. Diabetes
2. Poor circulation
3. Immunocompromised
4. Long-term corticosteroid use
5. Manicure
6. Constantly wet hands
7. Eczema (patient doesn’t have a normal skin barrier)

Question 7

What is the clinical presentation of paronychia

Answer 7

Hot
Red
Throbbing
Painful
*acute: red, warm, painful around nail, possible drainage
*chronic: pain, skin discoloration, nail discoloration

Question 8

What will be found on the PE? (Acute)

Answer 8

1. Pus is usually present along with gradual thickening and browning discoloration of the nail plate
2. Fever and axillary lymphadenopathy may be present

Question 9

What will be found on the PE? (Chronic)

Answer 9

1. Erythema and tenderness (less than acute)
2. Green discoloration due to Pseudomonas
3. Affected nail fold is swollen and lifted off the nail plate
4. Nail plate becomes distorted and ridged as it grows

Question 10

What are the lab tests to be completed?

Answer 10

1. Cultures (Acute)
2. Potassium hydroxide test (KOH)
   *smear of nail fold may reveal fungus

Question 11

What are the complications?

Answer 11

1. May progress to a felon
2. Herpes whitlow
   *cold sore

Question 12

What is the treatment (Acute)

Answer 12

1. Warm soaks 3-4 times a day to promote drainage
2. Antibiotics (cephalexin or dicloxacillin)
3. I&D if there is pus or abscess involved
   *a portion of nail may need to be removed

Question 13

What is the treatment? (Chronic)

Answer 13

1. Topical antifungal medication (ketoconazole cream for months to years)
2. Mild topical steroid to reduce inflammation (never use alone)
3. Nail removal
   *take off elevated nail then have the patient on an oral antifungal