ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (14)
Chronic paronychia - Nail and Distal Digit
Other Resources UpToDate PubMed

Chronic paronychia - Nail and Distal Digit

Print Patient Handout Images (14)
Contributors: Shari Lipner MD, PhD, Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed


Chronic paronychia is defined as inflammation of a nail fold (the skin surrounding the fingernails) that lasts longer than 6 weeks. Symptoms may include redness, swelling, and sometimes pain. Fluctuance is absent. There may be disruption or absence of the cuticle, and protracted cases may manifest with changes in the nail plate itself, including grooves and ridges. Nail plate involvement signals damage to the nail matrix, which lies deep to and proximal to the proximal nail fold. Acute paronychia with marked tenderness, erythema, and even abscess formation may complicate chronic paronychia or precede it.

There is debate as to whether chronic paronychia is primarily an infectious or an inflammatory disease process; the current view is that chronic paronychia is a species of chronic irritant or allergic hand dermatitis. Evidence includes frequent association with occupational exposures in dishwashers, bartenders, laundry workers, nurses, swimmers, fishmongers, and cooks and a study demonstrating the superiority of treatment with potent topical steroids over systemic antifungals. Women are more frequently affected than men. It usually affects multiple fingernails.

Infectious pathogens also play a role in this condition. The chronic inflammatory process compromises the nail fold barrier to entry of microorganisms. Superinfection with bacteria may result in acute paronychia as a sequela. Fungal colonization and/or infection, especially with Candida albicans, is common. In one study, Candida was cultured in over 90% of patients with chronic paronychia.

Certain drugs can cause drug-induced paronychia (potentially either acute or chronic). These include retinoids (isotretinoin, acitretin), methotrexate, antiretroviral protease inhibitors (indinavir, lamivudine), and epidermal growth factor (EGF) receptor inhibitors (cetuximab, gefitinib, lapatinib). In some cases, drug-induced paronychia is associated with periungual lobular capillary hemangiomas (pyogenic granulomas).

Diabetes mellitus, immunosuppression, and inflammatory dermatoses are risk factors for developing chronic paronychia.

Related topic: Candidal paronychia


B37.2 – Candidiasis of skin and nail

200744008 – Chronic paronychia

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Reviewed: 07/26/2017
Last Updated: 10/31/2017
Copyright © 2019 VisualDx®. All rights reserved.
Chronic paronychia - Nail and Distal Digit
Print 14 Images Filter Images
View all Images (14)
(with subscription)
Chronic paronychia : Absent cuticle, Nail fold erythema and edema, Nail pain, Periungual fingers, Scattered nails or distal digits
Clinical image of Chronic paronychia
Copyright © 2019 VisualDx®. All rights reserved.