Paronychia, chronic

Notes

## Basic introduction

  • Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens
  • It is an inflammation lasting for > 6 wks and involving one or more of the 3 nail folds
  • It is mainly caused by a fungal infection as well as inflammation
  • It is characterized by the separation of the cuticle from the nail plate. This leaves the region between the proximal nail fold and the nail plate exposed to infections
  • Frequent bouts of inflammation results in fibrosis of proximal nail fold and poor generation of cuticle. This exposes the nail even more to irritants and allergens
  • The risk factors for chronic paronychia include:
  • Finger sucking
  • Acute paronychia
  • Diabetes
  • Medicines such as retinoids, protease inhibitors and cetuximab (Anti-EGFR)
  • Nail biting (onychophagia)
  • Sucking of fingers
  • Washing/detergents
  • Splinter or thorn injury to a finger
  • An ingrown nail
  • Picking at a hangnail
  • Trimming of the cuticles harshly
Symptoms
  • Redness
  • Tenderness
  • Swelling
  • Fluid under the nail folds
  • Thick discolored nail
  • Induration and rounding off of the paronychium
  • Pitting
  • Longitudinal grooving of the nails
  • Onychomadesis (which is a periodic idiopathic shedding of the nails beginning at the proximal end)
Diagnosis
  • Clinical review
Differential
  • Herpetic whitlow
  • Squamous cell carcinoma or other malignancy
  • Myxoid cyst
  • Traumatic injury
  • Arthropod bite or sting
Prevention
  • Avoid risk factors (as previously stated under this topic)
Management
  • Chronic paronychia generally responds slowly to treatment.
  • Topical steroids (which are more effective than antifungals)
  • A broad-spectrum topical antifungal agent
  • Surgical interventions may include:
  • En bloc excision of the proximal nail fold
  • Eponychial marsupialization (with or without nail plate removal)
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