Paronychia: (Acute)

Presentation

The patient presents with finger or toe pain that has developed rapidly, either over the past several hours or over a few days. This pain is accompanied by a very red, tender swelling of the nail fold ( Fig. 148.1A ), or this swelling may be less red and tender or has developed granulation tissue and appears chronic in nature (see Fig. 148.1B ). Paronychia occur far more frequently in women, likely due to manipulation of the nails and eponychium for cosmetic reasons.

The nail is surrounded by the lateral, medial, and proximal nail folds. Injury (ingrown nail, hang nail, minor trauma) to either of these folds allows bacteria to enter the tissue. This results in local soft tissue infection with or without abscess formation.

Patients may also feature chronic paronychia, often due to chemical exposures seen in a variety of professions. Chronic paronychia is not considered a minor emergency; therefore treatment will not be discussed here. Patients with chronic paronychia should be referred to a hand specialist or podiatrist because more complex surgical procedures may be required. In addition, squamous cell carcinoma may have a similar appearance.

Extension of an acute infection under the nail plate is a subungual abscess (see Fig. 148.1C ).