What is Paronychia?

1. Acute paronychia: It often occurs after injury or minor trauma, and is characterized by painful suppurative infection, acute abscess formation (staphylococcus) or erythema and swelling (streptococcus).

Wang Aiping	(Chief physician)	Department of Dermatology, Peking University First Hospital

Paronychia is an inflammatory reaction involving skin folds around the nail, which manifests as acute or chronic suppurative, tender, and painful swelling of the nail tissue caused by nail fold abscess. When the infection becomes chronic, diaphragmatic crests appear on the bottom of the methyl group, and new crests appear with recurrence. Finger involvement is more common than toes. The main susceptibility factor is that the damage causes the nail epithelium to separate from the deck, and the pyogenic cocci or yeast can invade the wet nail ditch and nail fold secondary. The most common pathogenic bacteria are Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas, Proteus or Anaerobic bacteria; the most common pathogenic yeast is Candida albicans.

Western Medicine Name

Paronychia

English name

paronychia

Affiliated Department

Department of Physiology-Dermatology

Disease site

Nails

The main symptoms

Swelling of the tissues around the nail

Main cause

infection

Clinical manifestations of paronychia

1. Acute paronychia: It often occurs after injury or minor trauma, and is characterized by painful suppurative infection, acute abscess formation (staphylococcus) or erythema and swelling (streptococcus).

2. Chronic paronychia: Dermatitis is often caused by repeated minor trauma and exposure to water, irritants and allergens, followed by yeast colonization and secondary bacterial infection. The clinical features are inflammation of the proximal nail folds, manifested as painful erythema, edema, loss of nail crusts, and damage to the nail surface resulting in abnormalities of the deck surface. The chronic course overlaps with repeated self-limiting acute exacerbations. Tumors can sometimes show symptoms similar to chronic paronychia, such as Bowen's disease, keratoacanthoma, squamous cell carcinoma, endochondroma, and melanoma-free melanoma. Paronychia and pseudopyogenic granuloma may occur when taking certain drugs, such as systemic application of retinoic acid drugs, antiretroviral drugs, anti-epidermal growth factor antibodies and epidermal growth factor tyrosine kinase inhibitors. Can also be caused by some rare causes, such as inlay nails, skin Leishmaniasis and so on.

Paronychia laboratory test

Use swabs to take secretions for bacteriological and mycological examinations, and patch tests if necessary.

Paronychia disease treatment

1. Systemic treatment: Acute paronychia should be treated as soon as possible to prevent nail bed damage. The antibacterial spectrum can be selected to cover a wide range of aerobic and anaerobic bacteria, such as amoxicillin / clavulanic acid. If the symptoms do not improve within 48 hours, surgical treatment should be taken. Chronic paronychia is treated with antifungal drugs (the preferred azole drugs) or antibacterial drugs as needed. The treatment should be continued until the inflammation subsides, the nail skin rebuilds and adheres to the deck, which usually takes more than 3 months. For patients with recurrent acute exacerbations, intracutaneous or systemic application of glucocorticoids combined with systemic antibacterial drugs can be used for 1 week. Chronic paronychia caused by cetuximab can be given orally with doxycycline, 100 mg each time, twice daily.

2. Surgical treatment: When the infection is superficial and localized, incision and drainage can be performed. If the infection is deep, lift the proximal 1/3 of the deck under local anesthesia and place a drainage strip under the proximal nail fold to drain the secretions. Chronic paronychia secondary to inlays need only remove the deck.

3. Local treatment: topical azole antifungal drugs or topical clarithromycin solutions, combined with anti-inflammatory treatments, such as topical medium or strong glucocorticoid cream. For conventional treatment failure, surgical treatment or low-dose superficial radiation therapy can be taken. Drug-induced pseudopurulent granulomatous paronychia can be topically applied daily with 2% mupirocin / clobetasol propionate ointment.

Paronychia disease prevention

Chronic paronychia should avoid contact with water, irritants, allergens and trauma. Wear cotton gloves when in contact with water, and then put rubber or plastic gloves on the outside to keep your hands dry. Do not push nail folds and do not use nail polish. ^[1-3]