Paronychia refers to a common infection of the skin around the fingernails called the nail fold. This condition can be acute or chronic and is associated with defects in the cuticle that seals the space between the nail and its associated nail fold.
Bacteria and yeast are the organisms involved in these infections. Staphylococcus aureus and Streptococcus pyogens are the common causative organisms. Opportunistic infections can also occur due to Pseudomonas bacteria or the yeast called Candida albicans.
Acute paronychia is the term used for short-lived episodes while chronic paronychia describes infections, which last for over six weeks.
Acute infections develop over a few hours with pain, redness and swelling of the nail fold. Superficial infections form visible pus under the skin but deeper infections, can travel beneath the nail, and are associated with fever and painful lymph nodes.
Chronic infections wax and wane. Swelling of the nail fold is associated with absence of the cuticle and a space between the nail and the nail fold. This space provides a portal for recurrent infection resulting in episodes of redness and the discharge of small beads of pus. The nail matrix, which is the origin of nail growth, becomes infected. Initially horizontal ridges form in the nail but eventually it becomes irregular, thick and dark. Pseudomonas infection leads to a greenish black discoloration of the nail.
Jobs involving wet work predispose to paronychia. Bartenders, cleaners, car washers and nurses are examples of professions involving water, detergents and cleansers. Covering the hands for long periods in gloves containing moisture from water or sweat can also make things worst. Direct injury of the cuticle via poor manicures and nail biting or ill fitting artificial nails is not recommended.
Paronychia can be cured but it can take six months to one year in chronic cases. Recovery is dependent on lifestyle changes made by the patient as well as medical intervention.
GENERAL MEASURES
- Wash your hands carefully after dirty work with soap and water. Rinse your hands and dry completely.
- Keep your hands dry and moisturised with hand cream.
- Apply a barrier cream or Vaseline to the cuticle/nail fold area.
- Avoid wet work or use cotton inners and totally waterproof gloves. It is important to avoid sweating or getting water inside your gloves.
- Avoid biting your nails, manicuring the nail folds and pushing back your cuticles.
- Avoid false nails and nail polish until the problem is resolved.
- Control underlying diabetes or poor circulation
Acute paronychia is treated with warm compresses and oral antibiotics. Small abscesses are incised and drained. Larger abscesses under the nail require a partial nail excision to allow proper drainage. Dressings are required until fully healed.
Chronic paronychia involves mixed infection by bacteria and yeasts. The condition does not resolve until the cuticle grows back. This can take six to twelve months. Antifungal liquids and creams are used to treat minor yeast infections and in severe cases oral antifungals are used at intervals or for extended periods. Bacterial infection is treated using topical and oral treatments as well.
The disfigurement associated with chronic disease can cause depression and a poor quality of life when severe. The hands are used to touch and greet individuals we care about and this disease can result in shame and embarrassment. It is important to urge compliance and stress the need for the lifestyle changes necessary for recovery, as medical treatment alone does not work well. Early intervention can prevent acute disease from becoming chronic.
Visit your dermatologist early.