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Drug-induced paronychia - Nail and Distal Digit
Other Resources UpToDate PubMed

Drug-induced paronychia - Nail and Distal Digit

Contributors: Shari Lipner MD, PhD, Susan Burgin MD, Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed


Paronychia is inflammation of the nail folds and may be either acute or chronic. Acute paronychia occurs rapidly and is associated with redness, pain, and, in the case of infection, purulent drainage. Chronic paronychia lasts for more than 6 weeks and is associated with erythema, loss of the cuticle, and often nail dystrophy.

Acute paronychia is generally due to infectious etiologies, while chronic paronychia is typically due to irritants. Medications are also responsible for some acute and chronic paronychias and correlate with the introduction of the drug. Reported drug culprits include retinoids, lamivudine, cyclosporine, indinavir, azidothymidine (AZT), cephalexin, sulfonamides, cetuximab, gefitinib, fluorouracil (5FU), methotrexate, vandetanib, capecitabine, doxorubicin, and docetaxel. The paronychia typically resolves once the medication is discontinued.


T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

71906005 – Paronychia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Bacterial paronychia
  • Dermatitis of nail folds
  • Herpetic whitlow
  • Cutaneous squamous cell carcinoma
  • Pustular psoriasis
  • Primary syphilis
  • Ingrown toenail
  • Onychomycosis
  • Cellulitis
  • Occupation-related nail changes (eg, contact with Pesticide-induced nail changes or photo developers)
  • Topical application of therapeutic agents (eg, potassium permanganate, copper sulfate, anthralin)
  • Tobacco staining of nails
  • Artificial nail damage
  • Longitudinal melanonychia
  • Pecan nails exhibit a diffuse brownish hue of the dorsum of the nail plate.

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:07/20/2017
Last Updated:07/24/2017
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Drug-induced paronychia - Nail and Distal Digit
A medical illustration showing key findings of Drug-induced paronychia : Nail fold erythema and edema, Nail pain, Periungual fingers
Clinical image of Drug-induced paronychia - imageId=2717438. Click to open in gallery.
Copyright © 2024 VisualDx®. All rights reserved.