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General Medicine

Paronychia

Nancy Nguyen, D.O. Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Superficial inflammation of the lateral and posterior nail folds surrounding the fingernail or toenail. Develops after breakdown of barrier between nail plate and the adjacent nail f...

DIAGNOSIS

HISTORY

  • Localized pain or tenderness, swelling, and erythema of posterior or lateral nail folds

    • Acute: fairly rapid onset (2-5 days after trauma)

    • Chronic: at least 6 weeks’ duration

  • Previous tra...

TREATMENT

GENERAL MEASURES

  • Acute inflammation without abscess: warm water soaks or antiseptic soaks, and topical antibiotics. Consider oral antibiotics for more severe cases that do not respond to topi...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Acute: Postdrainage care consists of warm soaks or antiseptic soaks. Follow up in 24-48 hours after I&D to monitor for worsening infection.

  • Chronic: Avoid freq...

REFERENCES

1
Leggit JC. Acute and Chronic Paronychia. Am Fam Physician. 2017 Jul 1;96(1):44-51.
2
Lomax A, Thornton J, Singh D. Toenail paronychia. Foot Ankle Surg. 2016 Dec;22(4):219-223.
3
...

ADDITIONAL READING

Iorizzo  M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin.  2015; 33(2): ...

SEE ALSO

Onychomycosis, Retronychia 

CODES

ICD10

  • L03.019 Cellulitis of unspecified finger

  • L03.039 Cellulitis of unspecified toe

  • L03.011 Cellulitis of right finger

  • L03.012 Cellulitis of left finger

  • L03.031 Cellulitis of right toe

  • L03.032 Cellul...

CLINICAL PEARLS

  • Consider incision and drainage when appropriate.

  • For chronic paronychia, topical steroid is first-line treatment. Consider other differentials in nonresponders (e.g., rare causes: Rayna...

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Related Images
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Acute paronychia. Visible swelling, erythema, and discharge along the nail fold, yet the nail itself is intact.

Courtesy of Mary L. Brandt, MD.

 

Acute paronychia. Visible swelling, erythema, and discharge along the nail fold, yet the nail itself is intact.

Courtesy of Mary L. Brandt, ...

Elevation of the nail fold allows drainage of an abscess associated with an acute paronychia.

Thomas J. Zuber, E.J. Mayeaux JR., Atlas Of Primary Care Procedures. Philadelphia: Lippincott Williams & Wilkins, 2004.

 

Elevation of the nail fold allows drainage of an abscess associated with an acute paronychia.

Thomas J. Zuber, E.J. Mayeaux JR., Atlas Of Pr...

FIG. 25.1. Paronychia of the right middle finger. The infection is clearly localized to the dorsal surface (A), although the pulp is slightly swollen (B) due to edema.

 

FIG. 25.1. Paronychia of the right middle finger. The infection is clearly localized to the dorsal surface (A), although the pulp is sligh...

Chronic green nail in patient who does dishwashing

 

Chronic green nail in patient who does dishwashing

 

Onychomycosis: superficial white, big toe

 

Onychomycosis: superficial white, big toe

 

Onychomycosis: fingernails

 

Onychomycosis: fingernails

 

 

 

In-grown toenail

 

In-grown toenail

 
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