Chronic paronychia - Nail and Distal Digit
Alerts and Notices
SynopsisChronic 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.
B37.2 – Candidiasis of skin and nail
200744008 – Chronic paronychia
Differential Diagnosis & Pitfalls
- Acute paronychia – may complicate chronic paronychia
- Herpetic whitlow – one or more blisters near the nail with honeycomb appearance
- Onychocryptosis (ingrown nail)
- Pemphigus vulgaris
- Lobular capillary hemangioma
- Pustular psoriasis
- Acrodermatitis continua of Hallopeau
- Reactive arthritis
- Digital mucous cyst – usually not inflamed
- Squamous cell carcinoma or squamous cell carcinoma in situ (Bowen disease)
- Periungual verruca vulgaris – usually with verrucous surface and not inflamed
- Atypical mycobacterial infection – associated with cleaning fish tanks
- Retronychia – look for associated retronychia (proximal ingrowing of nail plate into central surface of proximal nail fold) as a cause for chronic paronychia. It affects the great toenail most frequently. A history of trauma or microtrauma, and the presence of a yellowish nail should prompt further suspicion for this condition.
Patient Information for Chronic paronychia - Nail and Distal Digit
OverviewParonychia, commonly known as 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 the result of a bacterial infection but can be caused by a yeast (Candida) or virus, typically the herpes simplex virus (HSV). This inflammation may occur in the short term or may be a long-term problem or one that keeps coming back (chronic).
Chronic paronychia occurs most often in people whose hands are constantly or often exposed to moisture. This type of nail infection may be complicated by the addition of a fungal infection, commonly due to a type of yeast called Candida, and this may lead to abnormal nail growth.
Who’s At RiskChronic paronychia is most common in adult women and those who work in places where their hands are kept moist, such as food handlers, but it has been seen in infants who suck on the thumb or fingers or whose caregivers over-trim the infant's fingernails.
Signs & SymptomsThe proximal nail fold can be swollen, red, and have no cuticle (the strip of hardened skin at the base and sides of a fingernail or toenail). One or more nails may be affected.
Self-Care GuidelinesAvoid water and chemical exposure to prevent symptoms of chronic paronychia.
When to Seek Medical CareSee your doctor for a checkup if you notice signs of bacterial nail infection (proximal nail fold is red, swollen, painful, and may contain pus).
TreatmentsFor chronic paronychia, your doctor may:
- Prescribe a topical steroid.
- Prescribe a topical antifungal medication.
- Prescribe antibiotics if a bacterial infection is present.
Chronic paronychia - Nail and Distal Digit