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Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Antonella Tosti, MD
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 nail folds. It may be acute (lasting for less than six weeks) or chronic (lasting for six weeks or longer) [1]. Predisposing factors include overzealous manicuring, nail biting, picking at a hangnail, thumbsucking, ingrown nail, diabetes mellitus, and occupations in which the hands are frequently immersed in water [2]. Paronychia has also been reported as an adverse effect of several drugs, including antiretroviral agents [3,4], systemic retinoids, epidermal growth factor receptor (EGFR) inhibitors, and cytotoxic chemotherapy agents [5,6].

This topic will discuss the pathogenesis, clinical manifestations, and management of acute and chronic paronychia. Ingrown toenails and other nail disorders are discussed separately. (See "Management of ingrown toenails" and "Overview of nail disorders" and "Nail psoriasis" and "Principles and overview of nail surgery" and "Nail avulsion and chemical matricectomy" and "Nail biopsy: Indications and techniques" and "Dermoscopy of nail pigmentations" and "Dermoscopy of nonpigmented nail lesions".)


Acute paronychia is an acute inflammatory process, with or without abscess formation, that involves the proximal and lateral nail folds and that has been present for less than six weeks [1,7].


Infectious agents — Acute paronychia is most commonly caused by the inoculation of pathogens present in the skin flora (eg, Staphylococcus aureus, Streptococcus pyogenes) into the periungual tissues by minor mechanical or chemical traumas that disrupt the nail fold barrier [7]. Other organisms that may be occasionally involved, especially in acute episodes occurring in patients with chronic paronychia, include Pseudomonas aeruginosa and other Gram-negative bacteria.

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 (eg, Fusobacterium, Peptostreptococcus, Prevotella, Porphyromonas spp) [8,9].

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Literature review current through: Nov 2017. | This topic last updated: Dec 09, 2017.
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