Overview
Paronychia is an infection or inflammation of the skin around the nail, often caused by bacterial or fungal pathogens, and can be acute or chronic. 1Diagnosis
Clinical Presentation: Pain, redness, swelling around the nail 1.
Physical Examination: Assess for warmth, fluctuance, and nail changes 1.
Laboratory Tests: Not routinely required unless severe or suspected deep infection; consider nail culture if chronic or unresponsive to treatment 1.
Differential Diagnosis: Differentiate from onychomycosis, herpetic whitlow, and other dermatologic conditions 1.Management
Acute Paronychia:
- Incision and Drainage: For fluctuant abscesses 1.
- Antibiotics: Oral antibiotics such as dicloxacillin or clindamycin for moderate to severe cases 1.
Chronic Paronychia:
- Topical Antifungals: For suspected fungal etiology (e.g., clotrimazole) 1.
- Avoidance of Trauma: Minimize nail trauma and irritants 1.
- Systemic Antibiotics: Considered if secondary bacterial infection is present 1.Special Populations
Pediatrics: More common due to nail bed trauma; conservative management often sufficient 1.
Elderly: Increased risk of complications; careful monitoring and prompt treatment recommended 1.
Comorbidities: Hypermobile individuals may have a higher incidence of ingrown nails, potentially predisposing to paronychia 1.Key Recommendations
Evaluate for generalized joint hypermobility in patients with recurrent ingrown nails or paronychia to identify potential predisposing factors (Evidence: Moderate 1).
Perform incision and drainage for acute paronychia with abscess formation (Evidence: Expert opinion 1).
Consider oral antibiotics for moderate to severe acute paronychia, selecting agents like dicloxacillin or clindamycin (Evidence: Moderate 1).References
1 Erdogan FG, Tufan A, Guven M, Goker B, Gurler A. Association of hypermobility and ingrown nails. Clinical rheumatology 2012. link