Paronychia is an infection that can be acute or chronic. Acute paronychia is abacterial infection of the nail fold. It is a common hand infection, usually only affecting a single digit. The nail fold will be tender, red, and swollen. In some cases, the finger will be fluctuant with pus. It usually occurs from injury or trauma in the paronychia fold, such as a hangnail, nail pitting, manicuring, or due to thumb sucking. Staphylococcus aureus is the most common organism that causes this infection.
If the condition is caught early, warm soaks of the finger can be done to treat it. Antibiotics can also be given to the patient, such as Clindamycin and Augmentin. If there is an abscess, surgery will need to be performed. To do so, and incision and debridement with partial or total nail removal should be done, along with antibiotics.
Chronic paronychia is different from acute paronychia, and therefore must be handled differently. It is a fungal infection of the nail fold, and therefore cannot be treated with antibiotics like acute paronychia can. The nail fold will swollen, inflamed, red, and tender, just like acute paronychia. However, there will be no abscess or pus. This infection is a lot less common, but can be recurrent. It is often seen in diabetics. Candida albicans is the most common organism that causes this infection.
Chronic paronychia often occurs in people who work in an environment with water and chemical irritant, such as washers, bartenders, gardeners, house keepers, or people dealing with laundry.
Risk factors of chronic paronychia include having diabetes, taking steroids, and/or taking retroviral drugs such as Indavir. This medicine causes paronychia in HIV positive patients, but the condition resolves when the Indavir is stopped.
To treat chronic paronychia, the patient should avoid water and use topical antifungal agents like Miconazole or topical steroids. Surgery is the last resort for treating paronychia, but marsupialization is used in severe resistant cases.
