Paronychia can be acute or chronic. It is an infection of the nail fold. It is a common hand infection, usually affecting a single digit. The nail fold will be tender, red, and swollen. It will sometimes be fluctuant with pus. It can happen from injury or trauma in the paronychia fold, such as a hangnail, nail pitting, manicuring, or due to thumb sucking. Staphylococcus aureus is the most common organism. If the condition occurs early, do warm soaks. You can give the patient antibiotics such as clindamycin or Augmentin. For abscesses, you will do surgery. Do incision and debridement (I&D) with partial or total nail removal, plus antibiotics. Chronic paronychia is different from acute paronychia. It is a fungal infection of the nail fold. Candida albicans is the most common one. Infection occurs more in diabetics. Multiple fingers can be involved. It does not respond to antibiotics. The infection is rare, but can be recurrent. There is no pus. The nail fold is swollen, inflamed, red, tender, and there is no abscess. Chronic paronychia occurs in people who work with a water environment and chemical irritants such as dish washers, bartenders, gardeners, house keepers, or in dealing with laundry. Risk factors include diabetics, patients who take steroids, and patients who take retroviral drugs such as Indinavir, which causes paronychia in HIV positive patients (the condition resolves when they stop taking the medication). To treat chronic paronychia, avoid water, use topical antifungal agents such as miconozole and topical steroids, and surgery at a last resort. Marsupialization is done in severe resistant cases.

Nabil Ebraheim, MD

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