Acute paronychia is an acute infection of the nail folds and periungual tissues, usually caused by Staphylococcus aureus.
Treatment of acute paronychia includes incision and drainage of any purulent fluid, soaks, and topical and/or oral antibacterials.
Chronic paronychia is a chronic irritant dermatitis of the periungual tissues resulting from barrier damage to the protective nail tissues, including the cuticle and the proximal and lateral nail folds.
Water and irritant avoidance is the hallmark of treatment of chronic paronychia.
From the collection of Dr NJ Jellinek and Professor CR Daniel III
- pain, swelling, drainage (acute)
- swollen, purulent nail fold (acute)
- nail plate irregularities (chronic)
- swelling/redness of nail folds (chronic)
- pink, swollen nail folds (chronic)
- missing cuticle (chronic)
- underlying nail plate abnormalities (chronic)
1st Tests To Order
- swab for Gram stain, culture, and sensitivity (acute or acute-on-chronic)
- swab for Tzanck smear (acute, herpetic)
Other Tests to Consider
- KOH or fungal culture (chronic)
- biopsy of skin/bone
- mild bacterial infection
- soaks + topical antibacterial + incision and drainage
- oral antibiotic therapy
- more tissue involved or severe bacterial infection
- soaks + topical antibacterial + incision and drainage + oral antibiotic therapy
- herpetic infection
- oral antiviral therapy
- education + moisture and irritant avoidance + topical corticosteroid
- treatment of secondary colonization of yeast or bacteria
- intralesional corticosteroids
- excision of proximal nail fold