Paronychia

The nail disease paronychia (commonly known as felon or whitlow) is an often tender bacterial or fungal infection where the nail and skin meet at the side or the base of a finger or toenail. It can start suddenly (acute paronychia) or gradually (chronic paronychia).

Description
The cuticle acts as a protective seal, but if it is damaged in any way then pathogens are able to enter the skin and cause infection. Despite the small area affected these infections can be extremely painful as the skin becomes inflamed, hot, red, and throbs continually. Pus is usually present, along with gradual thickening and browning discoloration of the nail plate. If a large amount of pus has collected, then it may be necessary to make a small cut in the skin (sometimes under local anaesthetic) to release it.

Acute paronychia is usually caused by bacteria. This is often treated with antibiotics, sometimes as a cream, other times orally. Chronic paronychia is most often caused by a yeast infection of the soft tissues around the nail but can also be traced to a bacterial infection. If the infection goes on and on then a fungal infection is often the cause and this needs anti-fungal cream or paint to treat it.

Most often it is trauma to the cuticle that allows infection in. Biting or picking at the cuticle, damage through work and overenthusiastic manicuring are the usual culprits. Individuals who work with their hands in water, such as health care workers and food processors, are quite prone to the fungal type of infection. Excess water weakens the seal and soaps or detergents will remove the protective skin oils, leaving the skin dry and more liable to split.

If someone has a cold sore and puts their finger in their mouth then a herpes infection whitlow may appear. Herpes whitlows are frequently found among dentists and dental hygienists. Prosector's paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specimens for dissection. Paronychia around the entire nail is sometimes referred to as runaround paronychia.

Painful paronychia in association with a scaly, erythematous, keratotic rash (papules and plaques) of the ears, nose, fingers, and toes, may be indicative of acrokeratosis paraneoplastica, which is associated with squamous cell carcinoma of the larynx.

Treatment
Paronychia Treatment

Self-Care at Home:
Care at home includes warm soaks in a mixture of 50% warm water and 50% liquid antibacterial soap 3-4 times daily for about 15 minutes. This soaking should be done at the first sign of redness around the nail.

Medical Treatment:
If an abscess (pus pocket) has formed, the recommended treatment is to drain the abscess by doing an incision and drainage procedure.

The doctor will most likely use medicine (such as lidocaine) to numb the entire finger first and then will open the abscess using a surgical knife (scalpel).

Sometimes packing called a wick is placed in the abscess to allow it to continue to drain when you go home and to keep it from closing up and re-forming the abscess. The packing is usually left in for 24-48 hours.

In extreme cases, infection can move under the fingernail and need partial or complete nail removal. Unless there is an extensive cellulitis (inflammation and infection of the soft tissue around the nail), antibiotics are usually not necessary.

Your doctor may or may not take a culture of the drainage to check for a bacterial infection.

After your doctor has drained the paronychia, warm soaks are still recommended. Usually, antibiotics are only prescribed if the infection involves more of the finger than around the nailbed. It is important to follow up with your doctor in 24-48 hours to be sure that the infection is healing properly