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- Inflammation of the lateral and posterior folds of skin surrounding the fingernail or toenail:
- Acute: Characterized by pain, erythema, and swelling; usually a bacterial infection, often appearing 2–5 days after trauma (1)
- Chronic: Characterized by swelling, tenderness, cuticle loss/separation, and nail dystrophy (1)
- May be considered work-related among bartenders, waitresses, nurses, and others who often wet their hands (1)
- System(s) affected: Skin/Exocrine
- Synonym(s): Eponychia; Perionychia
Thumb/Finger-sucking is a risk factor (anaerobes and Escherichia coli may be present).
- Common in the US
- Predominant age: All ages
- Predominant sex: Female > Male (3:1)
- Acute: Trauma to skin surrounding nail, ingrown nails, manicured/sculptured nails, diabetes mellitus (DM), nail biting, and thumbsucking
- Chronic: Frequent immersion of hands in water (e.g., cooks, chefs, bartenders, housekeepers, swimmers), DM, immunosuppression (reported association with antiretroviral therapy for HIV and with use of epidermal growth factor inhibitors)
- Acute: Avoid nail biting; prevent thumbsucking.
- Chronic: Avoid allergens; keep fingers/hands dry; wear rubber gloves with a cotton liner.
- Good diabetic control
- A paronychial infection usually starts in the lateral nail fold.
- Occasionally, the infection includes the complete margin of skin around the nail plate, which results from mechanical separation of the nail plate from the perionychium.
- Early in the course of this disease process (<24 hours), cellulitis alone may be present. An abscess can form if the infection does not resolve quickly.
- Chronic infections most likely represent eczematous reaction with secondary infection and multifocal etiology.
- Acute: Staphylococcus aureus and Streptococcus pyogenes; less frequently, Pseudomonas pyocyanea and Proteus vulgaris. In digits exposed to oral flora, also consider Eikenella corrodens, Fusobacterium, and Peptostreptococcus.
- Chronic: Eczematous reaction with secondary Candida albicans (~95%); less frequently, dermatophytes and, occasionally, molds (Scytalidium, Fusarium)
Commonly Associated Conditions
- Eczema or atopic dermatitis
- Certain medications: Cetuximab, paclitaxel, antiretroviral therapy (especially protease inhibitors and lamivudine, with toes more commonly involved)
- If multiple, consider pemphigus vulgaris (rare)