Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated September 2015.

Paronychia is inflammation of the skin around a finger or toenail. It can be acute or chronic.

Paronychia is also called whitlow. It may be associated with felon (infection of the pulp of the fingertip).

Who gets paronychia?

Acute paronychia can affect anyone. However, it is more likely to follow a break in the skin, especially between the proximal nail fold/cuticle and the nail plate. For example:

Chronic paronychia mainly occurs in people with hand dermatitis, or who have constantly cold and wet hands, such as:

Acute and chronic skin infections tend to be more frequent and aggressive in patients with diabetes or chronic debility, or that are immune suppressed by drugs or disease.

What causes paronychia?

Acute paronychia is usually due to bacterial infection with Staphylococcus aureus, or other bacterial pathogens less frequently. It can also be due to the cold sore virus, Herpes simplex.

The cause or causes of chronic paronychia are not fully understood. In many cases, it is due to dermatitis of the nail fold. Often several different micro-organisms can be cultured, particularly Candida albicans and the Gram negative bacilli, pseudomonas.

What are the clinical features of paronychia?

Acute paronychia

Acute paronychia develops rapidly over a few hours, and usually affects a single nail fold. This becomes painful, red and swollen. If herpes simplex is the cause, multiple tender vesicles may be observed. Sometimes yellow pus appears under the cuticle and can evolve to abscess. The nail plate may lift up. Acute paronychia due to Streptococcus pyogenes may be accompanied by fever, lymphangiitis and tender lymphadenopathy.

Chronic paronychia

Chronic paronychia is a gradual process. It may start in one nail fold but often spreads to several others. Each affected nail fold is swollen and lifted off the nail plate. The affected skin may be red and tender from time to time, and sometimes a little pus (white, yellow or green) can be expressed from under the cuticle.

More images of paronychia ...

What are the complications of paronychia?

Acute paronychia can spread to cause a serious hand infection (cellulitis) and may involve underlying tendons (infectious tendonitis).

The main complication of chronic paronychia is nail dystrophy. It is often associated with distorted, ridged nail plates. They may become yellow or green/black and brittle. After recovery, it takes up to a year for the nails to grow back to normal.

How is paronychia diagnosed?

Paronychia is a clinical diagnosis, often supported by culture of bacterial and viral swabs and/or nail clippings for mycology.

What is the treatment for paronychia?

Acute paronychia

Chronic paronychia

Attend to predisposing factors.

Treatment should focus on the dermatitis and any microbes grown on culture.

What is the outlook for paronychia?

Acute paronychia usually clears completely in a few days, and rarely recurs in healthy individuals.

Chronic paronychia may persist for months or longer, and can recur in predisposed individuals.

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