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Paronychia and ingrown toenails

Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Section Editors
Robert P Dellavalle, MD, PhD, MSPH
Moise L Levy, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Paronychia is an inflammation involving the lateral and proximal fingernail folds. Predisposing factors include overzealous manicuring, nail biting, thumbsucking, diabetes mellitus, and occupations in which the hands are frequently immersed in water [1]. Paronychia has also been reported in association with antiretroviral therapy for HIV infection [2,3] and with use of epidermal growth factor receptor (EGFR) inhibitors for cancer treatment [4].

Paronychia may be either acute or chronic (inflammation lasting longer than six weeks).

Acute paronychia is characterized by the onset of pain and erythema of the posterior or lateral nail folds, with subsequent development of a superficial abscess (picture 1A-C).

In digits without exposure to oral flora, acute paronychia is most commonly caused by skin flora (such as Staphylococcus aureus and Streptococcus pyogenes) [5].

In digits exposed to oral flora, acute paronychia may be caused by either skin or oral flora. In this setting, organisms include both aerobic bacteria (such as streptococci, S. aureus, and Eikenella corrodens) and anaerobic bacteria (such as Fusobacterium, Peptostreptococcus, Prevotella, and Porphyromonas spp) [6,7].


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Literature review current through: Apr 2017. | This topic last updated: Dec 08, 2016.
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