- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Antonella Tosti, MD
Antonella Tosti, MD
- Professor of Clinical Dermatology
- Department of Dermatology and Cuteneous Surgery, Miller School of Medicine, University of Miami
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
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) . 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 . 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]. Acute paronychia, often associated with periungual pyogenic granuloma-like lesions, has been reported in approximately 17 percent of patients treated with epidermal growth factor receptor (EGFR) inhibitors after two or more months of drug exposure .
Pathogenesis — 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 . Common favoring factors include manicuring, nail biting, thumbsucking, picking at a hangnail, and ingrowing toenails.
Other organisms that may be occasionally involved, especially in acute episodes occurring in patients with chronic paronychia, include Pseudomonas aeruginosa and other Gram stain-negative bacteria. Acute paronychia of the toes occurs in most cases in association with ingrown toenails . (See "Management of ingrown toenails".)
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- ACUTE PARONYCHIA
- Clinical presentation
- Differential diagnosis
- - Paronychia without abscess
- - Paronychia with abscess
- - Toenail paronychia
- CHRONIC PARONYCHIA
- Clinical presentation
- Differential diagnosis
- - General measures
- - First-line therapy
- - Refractory chronic paronychia
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS