Paronychia is a painful inflammation of the folds around the nails that manifests as redness and swelling in the nail fold, the fold of skin that surrounds the nail. Chronic paronychia has multiple causes, most often linked to the disappearance of the cuticle, while acute paronychia is essentially bacterial. Keeping hands dry and using antiseptics is usually sufficient to treat chronic paronychia. In case of infection, antibiotic treatment may be considered. Avoiding periungual injuries limits the risk of acute paronychia.

Definition

Paronychia is a periungual inflammation, that is to say an inflammation of the folds located around the nails.

Chronic paronychia is recurrent or permanent periungual inflammation. Acute paronychia is a bacterial infection of the nail cuticle.

Paronychia is usually acute but chronic cases can be seen.

Causes

Acute paronychia is caused by infection with bacteria (usually Staphylococcus aureus or streptococci) that enter the body through a skin lesion.

Chronic paronychia often results from contact hypersensitivity, and bacterial or mycotic superinfection is then secondary.

Other causes of different kinds can be at the origin of a chronic paronychia:

Mechanical causes:

• Repeated immersions in water
• Thumb sucked
• Manicure
• Onychotillomania, an obsessive-compulsive disorder that involves manipulating your nails

Dermatological causes:

• Contact eczema
• Psoriasis
• Bullous skin disease (large, circumscribed skin uplift filled with fluid that may be clear or cloudy)
• Onychomycosis, infections of the nail by a parasitic fungus

Drug causes:

• Retinoids, derived from vitamin A
• Antiretrovirals: indinavir, lamivudine
• Targeted therapies: anti-EGFR, mTOR inhibitors, anti-MEK

Tumor causes:

• Benign tumors
• Malignant tumors: squamous cell carcinoma, melanoma, metastases

Diagnostic

The diagnosis of paronychia is primarily clinical. Doctors make the diagnosis by examining the affected fingers, and asking the patient about the circumstances of their appearance, the pain felt, their medical history, their profession, etc.

Following a diagnosis of parochynia and in the absence of response to treatment, additional examinations may be prescribed (biopsy, mycobacteriological sample, radiology, etc.) and several other skin conditions should be considered:

• Squamous cell carcinoma
• Proximal onychomycosis, infection of the nail with a fungus
• Pyogenic granuloma: fleshy, moist or crusty nodules, red or reddish-brown in color consisting of a proliferation of capillaries which causes swelling of the surrounding tissue
• Pyoderma gangrenosum, skin necrosis
• Herpetic whitlow, a distal skin infection of the finger caused by the virus herpes simplex.

Risk factors

La chronic paronychia mainly affects people whose hands are in regular contact with water. This applies in particular to employees responsible for washing dishes in restaurants, bartenders and cleaning agents. People with eczema, diabetes, and immune depression are also more prone to chronic paronychia.

Factors favoring acute paronychia are all the minimal traumas that can cause skin lesions, the body’s gateway for bacteria: small wound, tearing of skin flaps around the nails, too much manicure with repression of the cuticle, artificial nails, onychophagia, suction thumb in children, nail incarnation …

Paronychia cause a set of clinical symptoms:

Redness and swelling

Paronychia, whether chronic or acute, causes redness and swelling in the nail fold (the fold of skin on the sides of the nail where the nail and skin meet)

Pain

The redness is accompanied by pain and a feeling of heat in the nail fold.

Accumulation of pus

In the case of a acute paronychia, pus may collect under the skin around the nail, and sometimes under the nail.

Nail deformation

Paronychia, whether chronic or acute, often results in loss of the cuticle (skin at the base of the nail) and detachment of the nail. This separation leaves a space which allows the entry of irritants and microorganisms. The nail is deformed.

Faced with chronic parochynia, the main treatment is to keep the hands dry to help close the skin lesions. Gloves or protective creams can be used if contact with water is necessary. Thymol (substance extracted from thyme essence with astringent and antiseptic properties) applied several times a day to the space left by the loss of the cuticle helps to keep this cavity dry and free from microorganisms. Some topical drugs (intended for application to the skin or mucous membranes) with anti-inflammatory properties help to improve, including corticosteroids and tacrolimus.

In the case of a acute paronychia, at the early stage, treatment is often based on the application of antibiotics such as dicloxacillin and cefalexin (anti-staphylococcal activity), or broader spectrum active ingredients such as clindamycin. At the same time, antiseptics help limit infection. At the stage of purulent abscess, if pus accumulates it must be drained. And frequent hot baths improve blood circulation.

The preventive treatment of acute paronychia consists in avoiding any periungual injury: fighting against onychophagia, not tearing or biting the skin around the nails, avoiding too aggressive manicures, wearing gloves for manual work, and carrying out local antisepsis of any wound, however small .

For people who are undergoing treatment that may lead to chronic paronychia, prevention is important. It calls for the wearing of comfortable shoes, gloves for manual work and the avoidance of excessive manicures.