Paronychia is the infection of the skin next to or at the base of the nail. The perionychium is the skin next to the nail which is protected by the cuticle. This infection can have a sudden onset (acute) or it may develop over a period of time.
Classification of paronychia
It can be classified easily into acute or chronic paronychia depending on the duration of the infection.
Causes of paronychia
- Infection of the skin around the nail and sometimes the nail itself is common among those who work with water frequently, such as cleaners, dishwashers, beauticians and dhobis.
- Injury to the area from a sharp object like a knife or an improper manicure or pedicure can also introduce infection.
- Children are infected due to their habit of sucking their thumb or putting fingers in the mouth.
Symptoms and signs of paronychia
Acute paronychia is characterised by red hot tender and inflamed skin close to the nail. The tenderness is due to pus formation and the area may sometimes need to be incised to drain the pus and accelerate healing. It is usually due to Staphylococcus bacteria but can be due to other types like streptococcus.
In chronic paronychia, there may be mild tenderness and redness. The nail may be discoloured and greenish tinge is seen in cases of Pseudomonas bacterial infection. In most cases, the causative agent is fungal usually candida.
Diagnosis of paronychia
The diagnosis is straightforward. Your doctor will take a detailed medical history and examine you. Acute paronychia is the most common hand infection.
Investigations to diagnose paronychia
It is not usually done. In some cases, a swab of the discharge may be taken for culture to find out which bacteria are causing the infection. In chronic cases, a potassium hydroxide test from a smear of the nail fold may show a fungus.
Treatment of paronychia
Soaking hands in warm water to which salt is added is good to relieve the inflammation and should be done twice daily till better.
Antibiotics are the treatment of choice for acute paronychia. There is little benefit from a local antibiotic ointment like mupirocin while oral cephalexin is a good choice for taking a five day course. If there is pus and abscess formation, it may need to be incised and drained.
Chronic paronychia is treated with antifungal drugs like ketoconazole. A steroid ointment can be prescribed to relieve the symptoms and speed up healing. Drugs are used for several months to completely remove the fungus.
Patients suffering from diabetes or have deteriorated immune systems due to tuberculosis, AIDS or long term corticosteroid usage may need to take a more extensive course of medicines to completely eliminate the infection.
In some untreated cases which are brought to medical attention at a later stage, the doctor may need to remove a part of the nail.
Prevention of paronychia
- Do not put your hands in water excessively as it leads to dryness and predisposes to paronychia. After washing, dry hands thoroughly.
- Do not bite nails or try to pull the skin overhanging the nail. Use a pair of scissors to trim the skin carefully.
- Use gloves if your work involves putting hands in water for long periods.
Photograph via sxc.hu
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