Bacterial paronychia in Adult
See also in: Nail and Distal DigitAlerts and Notices
Synopsis
Acute paronychia frequently arises from trauma to one of the nail folds, resulting in compromise of the physiologic barrier to entry of microorganisms. Inflammation may proceed to bacterial infection, resulting in pus. In some cases, the abscess tracks under the nail plate, and if not treated quickly, it can result in permanent damage to the nail matrix.
Examples of inciting trauma include foreign bodies, such as splinters; manipulations, such as manicures or pedicures; ingrown nails; fingernail biting; finger sucking in children; or "hangnail" removal. Occasionally, acute paronychia arises as a painful exacerbation of chronic paronychia, which is now understood to be a localized form of chronic irritant or allergic dermatitis.
Certain drugs – including retinoids (isotretinoin, acitretin), methotrexate, antiretroviral protease inhibitors (indinavir, lamivudine), and epidermal growth factor receptor (EGF) inhibitors (cetuximab, gefitinib, lapatinib) – can cause drug-induced paronychia, in some cases with associated periungual lobular capillary hemangioma (pyogenic granuloma).
Specific bacteria predominate in trauma-related acute paronychia. They include Staphylococcus aureus, Streptococcus pyogenes, and anaerobic bacteria derived from the oral flora. Mixed bacterial flora are common. Other bacteria that have been reported as causes include:
- Pseudomonas
- Enterococcus faecalis
- Enterobacter cloacae
- Proteus
- Hendersonula
- Scytalidium
- Fusarium
- Prevotella
- Bartonella
Codes
ICD10CM:L03.019 – Cellulitis of unspecified finger
SNOMEDCT:
247517004 – Bacterial paronychia
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Chronic paronychia – complicated by acute paronychia
- Trauma, including fracture of the distal phalanx – x-ray is indicated for a history of blunt trauma
- Herpetic whitlow – one or more vesicles near the nail with honeycomb appearance; painful
- Onychocryptosis (ingrown nail)
- Felon (purulent infection of the distal fingertip)
- Osteomyelitis
- Pemphigus vulgaris
- Lobular capillary hemangioma
- Pustular psoriasis
- Acrodermatitis continua of Hallopeau
- Reactive arthritis
- Digital mucous cyst
- Onychomycosis
- Syphilitic chancre
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Management Pearls
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Therapy
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References
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Last Reviewed:07/27/2017
Last Updated:07/21/2021
Last Updated:07/21/2021
Patient Information for Bacterial paronychia in Adult
Overview
Paronychia, commonly known as bacterial nail infection, is inflammation of the region of the finger or toe where the nail starts to grow, which is called the proximal nail fold (PNF). Paronychia is usually caused by a bacterial infection but can be caused by a yeast or virus, typically the herpes simplex virus (HSV). This inflammation may occur all of a sudden or may be a long-term problem or one that keeps coming back (chronic).Bacterial paronychia develops fairly quickly over a period of days along a break in the skin and is usually seen at the side of the nail.
Who’s At Risk
Bacterial paronychia may occur at any age but is particularly common in children.Signs & Symptoms
Bacterial nail infection most often affects the proximal nail fold of the fingers and less commonly affects the toes.The proximal nail fold is red, swollen, painful, and may contain pus. Usually one nail is affected.
Self-Care Guidelines
Try soaking the nails in warm water.When to Seek Medical Care
See your doctor for an evaluation if you notice signs of worsening infection.Treatments
For bacterial paronychia, your doctor may:- Puncture and drain the affected area and test for bacteria.
- Prescribe antibiotics for a bacterial infection.