Ep 147 – Paronychia

Paronychia is a common condition affecting the proximal and lateral nail folds of the hands or feet. In this episode, Dr Kate Chesterman discusses the differences between acute and chronic paronychia and the thinking around the causes and treatment of each. She also gives some tips that we can pass on to our patients regarding self-management and prevention.

Key take-home points

• Paronychia is a common condition affecting the proximal and lateral nail fold.
• Disruption to the epidermis or cuticle allows bacteria to be introduced to the area and predisposes to infection.
• Acute paronychia is present for less than 6 weeks and can occur spontaneously or because of trauma. It is usually painful, and the affected nail fold becomes hot, red and swollen.
• Staphylococcal infections are common in acute paronychia, but streptococcal and pseudomonas infections can also occur. Herpes simplex infections need to be considered in the presence of lancinating pain and vesicles.
• Management of acute paronychia should be with warm soaks, simple analgesia and consideration of topical or oral antibiotics.
• Acyclovir is needed for herpes simplex infections.
• An incision and drainage may be needed if a collection of pus or an abscess is present.
• Chronic paronychia has been present for more than 6 weeks. It usually results from an inflammatory dermatosis of the nail folds. Each affected nail fold is swollen and lifted off the nail plate, and this allows the entry of organisms and irritants.
• Chronic paronychia is predominantly a disease of those whose occupations result in prolonged exposure to water and chemicals. It also occurs in those with underlying skin conditions, in children who suck their thumbs or fingers and in those who have poor blood circulation or diabetes.
• Management of chronic paronychia includes treatment of any underlying skin or medical condition and the avoidance of further irritants. Topical treatments with steroids and anti-fungal creams may be needed. Occasionally, oral antifungals may be required.
• To prevent recurrence, we can advise that toenails should be cut straight across, and ingrowing nails need to be avoided. Nails should not be trimmed too short. Patients should be advised to avoid nail biting or finger-sucking and to dry their hands thoroughly after washing. Gloves and artificial nails should be avoided for prolonged periods, and if it is necessary to work in water cotton-lined rubber gloves should be worn.

Key references

1. PCDS. 2024. https://www.pcds.org.uk/clinical-guidance/paronychia.
2. Dermnet. https://dermnetnz.org/topics/paronychia.
3. Dulski A, Edwards CW. StatPearls [internet]. 2023. https://www.ncbi.nlm.nih.gov/books/NBK544307/.
4. Patient.info. https://patient.info/skin-conditions/paronychia-leaflet.
5. St George’s University Hospitals NHS Foundation Trust. https://www.stgeorges.nhs.uk/wp-content/uploads/2022/03/CYPED_PAR.pdf.
6. British Association of Dermatologists. 2022. https://www.skinhealthinfo.org.uk/condition/chronic-paronychia/.
7. British Association of Dermatologists. 2023. https://www.skinhealthinfo.org.uk/condition/how-to-care-for-your-hands/.