Paronychia

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Acute paronychia — An acute paronychia usually occurs as a sudden, very painful area of swelling, warmth and redness around a fingernail or toenail, usually following an injury to the area. An acute paronychia typically is caused by an infection with a mixture of bacteria that invade the skin where it has been damaged. This damage is often the result of overaggressive manicuring (especially cutting or tearing the cuticle), biting the edges of the nails or the skin around the nails, picking at the skin near the nails or sucking on the fingers.

Chronic paronychia — A chronic paronychia is an infection that usually develops slowly, causing gradual swelling, tenderness and redness of the skin around the nails. It usually is caused by Candida or some other species of fungus, an organism similar to mushrooms, molds and mildew. It often affects several fingers on the same hand. People with a higher-than-average risk of chronic paronychia include those with diabetes or workers whose jobs constantly expose their hands to water or chemical solvents. Such jobs include bartending, house cleaning, janitorial work, dentistry, nursing, food service, dishwashing and hairdressing.

An acute paronychia causes throbbing pain, redness, warmth and swelling in the skin around a nail. In some cases, a small collection of pus forms under the skin next to the nail, or underneath the nail itself. Often, only one nail is affected. A chronic paronychia usually causes less dramatic symptoms than an acute paronychia. Typically, 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." Several nails on the same hand may be affected simultaneously. Chronic paronychia is not caught from someone else. The germs that cause it are known as ‘opportunistic pathogens’. This means that they can damage you only if they are given the chance - when a chink appears in the body’s defences. In the case of chronic paronychia, this is often a split in a cuticle, which normally protects and seals off the potential space between the nail and the nail fold.

Treatment of the infection is usually a topical cream or lotion. Frequently prescribed lotions may include thymol in lidex, mupirocin, Loprox or Lotrisone. Apply these twice daily to the nail fold, and be prepared to use them regularly for some time. Other treatment strategies include liquid waterproof bandages such as flexible collodion or "New-Skin" and, for resistant cases a course of an oral anti-fungal agent (Itraconazole or fluconazole). It often takes months to clear paronychia, and it can recur in predisposed individuals.

In many cases, you can begin self-treatment by soaking the affected finger or toe in warm water. Do this for at least 15 minutes, two to four times a day. If your symptoms do not improve with this treatment, or if pus develops near the nail, call your doctor for further evaluation. If you have a moderate or severe paronychia, your doctor will treat it with antibiotics, such as dicloxacillin (Dycill, Pathocil), cloxacillin (Tegopen), erythromycin (E-Mycin and other brand names) or cephalexin (Keftab). You also will be told to elevate the injured finger or toe, and to soak the infected area in warm water two to four times a day. If you have an accumulation of pus near the nail, the doctor will numb the area and drain the pus. If necessary, a small portion of your nail will be removed to ensure that the area drains completely.

Since most cases of chronic paronychia are caused by fungi, your doctor will treat the infection with antifungal medication that is applied to the skin (topical medication), such as clotrimazole (Lotrimin, Mycelex) or ketoconazole (Nizoral). Full treatment may require several weeks of daily applications. You will also be reminded to keep the affected skin clean and dry. Rarely, in severe cases, you will need to take oral antifungal drugs or steroids by mouth.