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PARONYCHIA FINGER

Introduction

Paronychia is a bacterial infection of the nail fold. In acute paronychia, the cultured bacterium is usually Staphylococcus aureus. It is typically caused by nail biting and manicures. Chronic paronychia is a different disease process, and the cultured bacterium is usually Candida albicans. Chronic paronychia affects individuals whose hands are exposed to water or wet environments for long periods of time, such as kitchen and laundry workers, bartenders and swimmers.

Related Anatomy

  • The perionychium includes the hyponychium, the paronychium ( lateral nail fold), the proximal nail fold and the eponychium. The eponychium produces the non-living keratinized layer, the cuticle, that coats the surface of the nail plate.  The nail plate with its lunula covers the germinal matrix and the sterile matrix.

Incidence and Related Conditions

  • Paronychia accounts for 35% of infections of the hand.
  • Paronychia is more common in women than in men, with a female-to-male ratio of 3:1.

Differential Diagnosis

  • Candidiasis
  • Felon finger
  • Herpetic whitlow
  • Glomus tumor
  • Malignant melanoma
ICD-10 Codes

  • PARONYCHIA FINGER

    Diagnostic Guide Name

    PARONYCHIA FINGER

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    PARONYCHIA FINGER L03.012L03.011 

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
Paronychia
  • Early paronychia with previous nail damage
    Early paronychia with previous nail damage
  • Late paronychia with dorsal blister from swelling
    Late paronychia with dorsal blister from swelling
  • Paronychia right index finger
    Paronychia right index finger
  • Gouty tophus not paronychia
    Gouty tophus not paronychia
  • Herpetic Whitlow (viral infection) Don't operate
    Herpetic Whitlow (viral infection) Don't operate
Basic Science Photos and Related Diagrams
Related Anatomy
Basic Science Pics
  • Fingernail Surface Anatomy
    Fingernail Surface Anatomy
Symptoms
Redness, swelling and pain at the base of the fingernail
Sealing nail fold with nail polish or injury to nail fold
Typical History

The patient is usually complaining of a warm, red and painful area at the base of the fingernail. The patient may have a history of injury or that she/he recently had nails done. Fever is rare but can occur. There maybe purululent drainage from under the nail fold.

Exams, Signs and Tests Links
Work-up Links
Treatment Options
Conservative
  • Oral antibiotics and soaks
  • IV antibiotics
  • Topical steroids
  • Topical and systemic antifungal
  • Combination of topical steroid and antifungal
Operative
  • Surgical I & D with eponychial marsupialization with or without nail plate removal
  • Surgical I & D with en bloc excision of proximal nail fold (PNF)
  • Surgical I & D with en bloc excision of PNF with nail plate removal
  • Surgical I & D with Swiss roll technique
Treatment Photos and Diagrams
Paronychia Finger
  • Paronychia Long Finger
    Paronychia Long Finger
  • Paronychia Long Finger after I&D of nail fold and excision of proximal nail
    Paronychia Long Finger after I&D of nail fold and excision of proximal nail
Complications
  • Secondary felon (pulp Abscess)
  • Osteomyelitis
  • Recurrences
  • Nail deformities
Outcomes
  • Topical steroids are more effective than are systemic antifungals.
  • In one study of patients who had en bloc excision of PNF with nail avulsion, 70% were cured; of those who had en bloc excision of PNF without nail avulsion, 41% were cured.1
Key Educational Points
  • Presence of vesicles suggests herpetic whitlow
  • Green coloration may suggest Pseudomonas
  • Nail plate hypertrophy may suggest fungal infection
  • Severe pain with nail plate elevation, bluish discoloration and blurring of the lunula suggests glomus tumor
  • A common culture in the chronic paronychia is C. Albicans.
  • Chronic paronychia is treated by eponychial marsupialization.
  • Herpetic Whitlow is a viral infection that requires treatment with antiviral medications and should NOT be treated with surgical incision and drainage.
  • Incision and drainage of a herpetic whitlow can cause the simple often self-limited viral infection of a digit to be complicated by an encephalitis.
References

Cited

  1. Grover C, Bansal S, Nanda S. En bloc Excision of proximal nail fold for treatment of chronic paronychia. Dermatol Surg 2006;32:393-8. PMID: 16640685

New Articles

  1. Allouni A, Yousif A, Akhtar S. Chronic paronychia in a hairdresser. Occup Med (Lond) 2014;64(6):468-9. PMID: 24985481
  2. Pabari A, Iyer S, Khoo CT. Swiss roll technique for treatment of paronychia. Tech Hand Up Extrem Surg 2011;15(2):75-7. PMID: 21606775

Reviews

  1. Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg 2014;22(3):165-74. PMID: 24603826
  2. Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol 2014;59(1):15-20. PMID: 24470654

Classics

  1. Hayward R. Chronic paronychia. Can Med Assoc J 1962;86(6):292. PMID: 20327031
  2. Lowden TG. Paronychia. Lancet 1953;1(6751):118-21. PMID: 13011975
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