History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include microscopic or macroscopic injury to the nail folds and cuticle, adults exposed to occupational contactants or cosmetics or certain medicines, female sex, and toddlers who suck their fingers.

pain, swelling, drainage (acute)

Common complaint in acute paronychia.[Figure caption and citation for the preceding image starts]: Acute paronychiaFrom the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends].com.bmj.content.model.Caption@178b2c64[Figure caption and citation for the preceding image starts]: Acute paronychia: draining pusFrom the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends].com.bmj.content.model.Caption@48da6c78

swollen, purulent nail fold (acute)

Characteristic of acute paronychia on examination.[Figure caption and citation for the preceding image starts]: Acute paronychia: draining pusFrom the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends].com.bmj.content.model.Caption@100e3e55

nail plate irregularities (chronic)

Common complaint in chronic paronychia.[Figure caption and citation for the preceding image starts]: Chronic paronychiaFrom the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends].com.bmj.content.model.Caption@558254d6[Figure caption and citation for the preceding image starts]: Chronic paronychiaFrom the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends].com.bmj.content.model.Caption@1507deea

swelling/redness of nail folds (chronic)

Common complaint in chronic paronychia.

pink, swollen nail folds (chronic)

Characteristic of chronic paronychia on examination.

missing cuticle (chronic)

Characteristic of chronic paronychia on examination.

underlying nail plate abnormalities (chronic)

Characteristic of chronic paronychia on examination.

Risk factors

strong

microscopic or macroscopic injury to the nail folds (acute)

This is the only portal of entry for microbes into the periungual tissues.

occupational risks (acute and chronic)

Work-related trauma to the nail folds creates the portal of entry and causes disruption in the nail barrier due to exposure to irritants.

barrier damage to the nail folds, cuticle (chronic)

The normal barrier is impermeable to microbes, moisture, and irritants. Any manipulation or loss of this barrier exposes the normally protected tissue under the proximal nail fold to persistent and cumulative moisture, microbe, irritant, and occasional allergic contactants. This cycle of inflammation persists until the insults are removed and the normal nail barrier is reformed.

ingrown nail

An ingrown nail may develop into paronychia.

Chronic paronychia and interruption of nail growth may occur subsequent to post-traumatic ingrowth of the proximal nail plate into the proximal nail fold (retronychia).[4][5]

medications (chronic)

Nail changes are well documented among patients receiving certain chemotherapeutic agents (e.g., taxanes) and epidermal growth factor receptor inhibitors.[6][7] Other medications that can cause chronic paronychia include retinoids and protease inhibitors.[3]​

weak

toddler and adult

All ages can be affected, but peak incidence is in toddlers (finger suckers) and adults.

female

Females are more likely to be affected than males.

Use of this content is subject to our disclaimer