What is Paronychia?
Paronychia is a fairly common superficial infection affecting the epithelium around the nails. This can affect the nails on the fingers and the toes. Once the infection sets in, the area would become swollen, red, and painful and might even form blisters that are filled with pus. Paronychia is considered to be a minor case of nail infection; however, in some rare cases, the infection might be so severe that it may spread to the rest part of the fingers or toes and develop to more serious infections. When this happens, a visit to the doctor is recommended.
Initially, the symptoms of paronychia are the typical signs of inflammation such as redness and swelling around the nail; this resembles cellulitis. Most of the time, the area affected are painful and tender to touch, and in some cases, they assume a yellow-green color, which means that there is already an abscess formation on the affected area.
Depending on the type of paronychia, they actually have different onset. Bacterial paronychia appears suddenly while fungal paronychia may take longer to develop; therefore the latter may develop the symptoms much later than the former type. Whether bacterial or fungal, chronic paronychia however will cause a typical symptom on the affected nail. They assume a different color and appear as though they are detached from the nail bed.
Causes of Acute Paronychia
Acute paronychia are caused by the following:
- Acute paronychia happens to patients who have a history of minor trauma to the finger may it be intentional or not. This minor trauma may have altered the physical barrier that protects the nail and the nail bed. The damage brought about by the trauma will allow entry of the infectious organisms.
- This may also be caused by innocuous conditions such as hangnails and activities as nail biting, manicuring, or artificial nail placement.
- The most common cause of paronychia is the Staphylococcus bacteria. Other causative agents are Streptococcus and Pseudomonas.
- Both acute and chronic cases may also be brought about by other medical health conditions such as pemphigus vulgaris.
Causes of Chronic Paronychia
Chronic paronychia can be caused by the following:
- The primary causing agent of chronic cases of paronychia is the yeast fungus Candida albicans.
- Other causative factors include bacterial, mycobacterial, or viral infection. Still others also include metastatic cancer, squamous cell carcinoma, and Raynaud’s disease.
To fully understand the mechanism of infection of paronychia, a little review on the anatomy of the finger would facilitate better understanding of the condition.
Longitudinally, the nail has two lateral folds or perionychium, which is covered by the eponychium proximally and by the hyponychium distally. The hyponychium serves as the strong physical barrier that prevents bacterial infection. The nail bed, where the nail plate lies, consists of two important portions which play essential roles in the production, migration, and maintenance of the nail itself. The proximal part of the nail bed is called the germinal matrix, wherein growth and of new cells occur. Damage to the germinal matrix would result to malformed nails. The second important part is the distal portion or the sterile matrix and is responsible for the nail’s thickness, bulk, and strength. The nail bed receives nourishment from the two terminal branches of the volar digital artery. A fine network of venous drainage is provided in the proximal nail bed and in the skin proximal to the nail fold of the finger. Note that the nail fold is the area where the nails arise. The same network is followed by the lymphatic vessels. These lymphatic vessels are said to be denser in the nail beds, particularly in the hyponychium. The trifurcation of the dorsal branch of the volar digital nerve provides innervation to the nail bed, which are spread to the nail fold, the pulp, and then to the distal tip of the finger.
The main pathophysiology of paronychia, whether it is acute or chronic, is that any damage to the protective area between the nail and the nail fold would result to the convenient entry of bacteria or fungi to the moist nail crevice. Once inside, these organisms will colonize the area that eventually they will cause damage and infection.
The treatment of paronychia depends on the severity of the condition. If symptoms are detected early, paronychia without abscess formation can be treated nonsurgically. However, in the presence of abscess, it can be managed by draining the pus through a small incision.
For acute paronychia, the affected finger would benefit in warm soaks for 3–4 times in a day until symptoms are relieved. Concurrent with the warm soaks, antibiotics such as amoxicillin and clavulanic acid or clindamycin can also be given to the patient.
For chronic paronychia, since they are aggravated when exposed to moist areas, then avoiding situations that would expose the fingers to such environment is apparent. Keeping the affected area dry is critical to its recovery. Protect the area by wearing essential footwear that would fully shield the affected toes from opportunistic organisms and situations alike that would aggravate the symptoms. In addition, avoid any manipulation done on the nail such as manicuring, nail biting, and finger sucking to prevent secondary bacterial infections.
Chronic paronychia can be managed medically by applying topical antifungal creams. Initial agents to use may include topical miconazole. In more severe cases, the doctor may prescribe oral ketoconazole or fluconazole.
Surgical management can be sought if paronychia is not resolved despite the best medical management given. For acute paronychia, the no-incision procedure is usually followed. The pus can be drained simply by elevating the eponychial fold by using a small blunt instrument. This is done in the area between the perionychium and the eponychium and extends a bit proximal, enough to get a better view of the proximal edge of the nail. Afterwhich, the proximal third can be excised and the pus will be drained. Note that this technique did not require any invasion into the matrix.
For chronic paronychia, the common surgical procedure done is the eponychial marsupialization. In this technique, it involves anesthetizing the affected digit with 1% lidocaine. A crescent-shaped incision is made proximal to the distal edge of the eponychial fold. All the affected tissues within the boundaries of the crescent-shaped area all the way down, but excluding the germinal matrix, are all excised. The excised part is packed with plain gauze and changed every 2–3 days. Epithelialization is expected to happen over the next 2–3 weeks, and nail improvement will occur in the next 6–9 or up to 12 months.
Collection of Photos, Images and Pictures of Paronychia…
Pictures of Paronychia