Let’s talk paronychia

Paronychia refers to an infection around the tissue surrounding the nail that often begins around the nail fold. It affects the fingernails more often than the toenails.

To understand paronychia better, it is important to understand the structure of the nail shown in the picture below. The nail is protected on both sides by the nail folds and the cuticle just below. Anything that causes a damage to these areas exposes the tissues around the nails to invasion by microorganisms. These microorganisms may be fungal or bacteria.

There are two types of paronychia: Acute and Chronic paronychia. Acute paronychia is usually caused by bacteria especially staphylococcus, streptococcus or pseudomonas and often presents dramatically with intense pain, swelling and redness around the nail. There may be a collection of pus around the nails and it may later involve deeper layers and become an abscess.

Chronic paronychia on the other hand presents over a longer period in a less intense way with minimal or no pain and a slight swelling around the nails. There may be associated nail infection and discoloration. It is often caused by a fungi called Candida species.

Several risk factors exist for paronychia which include nail biting, finger sucking, people who do manicure and pedicure that yank off their cuticles (NEVER ALLOW THEM TAKE OFF YOUR CUTICLES OR NAIL FOLDS), regular use of nail glue, occupations that involve putting hands in water for a long time like housekeeping, washing, swimming instructors amongst others. Immune suppression from diseases like HIV, malignancies, longterm use of drugs like steroids and some certain diseases like Diabetes mellitus, excessive sweating (called hyperhidrosis) are also predisposing factors.

The diagnosis of paronychia is usually clinical supported by laboratory tests to assess for the presence of bacteria or fungi depending on whether it is acute or chronic.

Management depends on the type and severity. For mild ones, mild rinses with saline or warm compresses with use of analgesics may suffice. Once there is a collection especially in the case of acute paronychia, surgical drainage becomes necessary together with use of appropriate antibiotics. For chronic paronychia, antifungals would be needed for treatment and for the appropriate duration.

In addition to this, it is also important to counsel the patients to avoid work that involves immersing their hands in water (wet work) and to use protective latex free gloves if they have to do wet work. It is also important to stop all other harmful practices like nail biting, nail glue use and most importantly…please leave your nail folds and cuticles alone!

Individuals with recurrent paronychia will need long term monitoring and follow up. They also need to be counseled on the need to avoid all the risk factors mentioned earlier that may put them at risk of recurrence. Any identifiable cause of immune suppression should be addressed.

Did you know that the Yorubas call paronychia ‘àkàndùn’?