DEFINITION

Paronychia is the infection and inflammation of periungual tissues.

RISK FACTORS

 Diabetes melitus
 Obesity
 Immune suppression
 Drugs such as Indinavir and Lamuvidine
 Nail biting and finger sucking
 Acrylic nails and nail polish
 Frequent water use

CAUSATIVE MICROORGANISMS

 Staphylococcal aureus
 Candida albicans

TYPES OF PARONYCHIA

Depending on the onset:

1. ACUTE PARONYCHIA .

It is when the infection is less than six weeks. It is mostly caused by a bacterium.it
mainly starts at the paronchyium. It presents with pain , swelling , pus formation and
inflammation. It is caused by trauma to the cuticle.

2. CHRONIC PARONYCHIA .

It is the infection of the nail tissue for more than six weeks. It common in people
whose hands work in moist environment such as house keepers, bar tenders and dish
washers. The condition is brought about by fungal infection following irritant
dermatitis. The cuticle between proximal nail fold separates leaving it susceptible to
infection. The nail fold appears tender, swollen and fibro tic .Some of the major
causes are dish washing, harsh pedicure procedures such as trimming of nail cuticles
and frequent contact with chemicals.

Depending on causative organisms;

3. Candida Paronychia

. It is caused by fungal infection of candida albicans species.

4. Pyogenic Paronychia.
It is the inflammation of nail tissues caused by bacteria.

CLINICAL PRESENTATION

 Redness
 Swelling of nail fold
 Pain
 Pus discharge
 Absent cuticle
 Beau lines of cuticle
 Warmth

PHYSICAL EXAMINATION FINDING

ACUTE PARONYCHIA

 Erythematus and swollen nail fold

 Pus collection on lateral fold
 Extension to eponychium causing eponychia
 Runaround infection involving both lateral folds
 Concomitant felon from infection of proximal skin of the finger.

CHRONIC PARONYCHIA

 Nail folds are swollen, erythematus, and tender without purulence.

 Thickened, dis coloured and pronounced transverse ridges of the nail plates.
 Separation of the cuticle and the nail fold.

Others signs include;

 Vesicles on erythematous bases suggests hepatic whit low
 Greenish discoloration of the nail to show pseudonymous infection
 Hypertrophied nail plate in cases of fungal infection
 Constant pain, blurring of the lunula and bluish discoloration of the nail plates
may suggest glomus tumour

DIFFERENTIAL DIAGNOSIS

1. Cellulitis

It is a superficial which presents as erythema and swelling but has no pus.

2. Whit low

It is also known as a felon. It is infection of pulp cavity. It is warm , red , tender and
painful . it treated through longitudinal incision and blunt incision to ensure adequate
drainage.

3. hepatic whit flow

It is viral infection on the distal finger. It is caused by HSV. It presents as burning

pruritus infection before initial infection. It has vesicles and pustules along with pain
and erythema.

4. Onychomycosis

It is fungal infection of the nail. It presents as whitish yellowish discoloration.

5. Nail psoriasis

It presents as nail thickening with areas of pitting, ridges, irregular contour and with
raising of the nail beds.

6. squamous cell carcinoma

It is nail cancer of nail bed.it is often misdiagnosed for chronic Paronychia. Biopsy is
crucial for its diagnosis
 TREATMENT

CONSERVATIVE MANAGEMENT

 Warm socks in toe nail infection

 Avoidance of moisture environment
 Keeping the affected area dry
 Avoidance of practices such as manicure, finger sucking and attempting to drain
the pus at home.

MEDICAL MANAGEMENT

 Topical antibiotics eg bacitran , mupirocin. It used for mild cases.

 Oral antibiotics eg dicloxacillin, cephalexin for severe cases and in areas of
MRSA.
 In cases of oral inoculation through nail biting and finger sucking use
clindamycin or amoxicillin-clavulanate (augumentin).
 Topical anti-fungal agents such as miconazole. Used for first line management of
chronic Paronychia. For severe cases ketoconazole or fluconazole may be added.

SURGICAL MANAGEMENT

 Incision and drainage of the pus

 Surgical debridement for fulminant infections
 Irrigation with isotonic sodium chloride and packing with gauze keeps cavity dry
and drains it

Surgical techniques

Simple incision technique

Tools needed ;18 gauge needle

Procedure ; insert the needle horizontally through nail surface to point of maximum
fluctuance.
 Lift the skin of nail fold to release the pus.
Side to side motion to increase size of incision.
Apply pressure on the skin to drain the pus.
Irrigate the cavity with saline .
Cover with sterile gauze or bandage.