Dermatologic Manifestations of Paronychia 

  • Author: Allison Vidimos, MD, RPh; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 10, 2010
 

Background

Paronychia is a soft tissue infection around a fingernail. Paronychia occurs in 2 forms: acute and chronic. The etiology, infectious agent, and treatment are usually different for each form, and the 2 forms are often considered separate entities.

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Pathophysiology

Mechanism

Paronychia, whether acute or chronic, results from a breakdown of the protective barrier between the nail and the nail fold. The entry of organisms into the moist nail crevice results in the bacterial or fungal (yeast or mold) colonization of the area.

Anatomy

The anatomy of the nail complex is shown in the image below. The nail is longitudinally flanked by 2 lateral folds or perionychium. Proximally, it is covered by the eponychium. Distal to the perionychium, the region immediately beneath the free edge of the nail is the hyponychium. The hyponychium serves as a tough physical barrier that resists bacterial infection.

Depicted are the nail fold (A), dorsal roof (B), vDepicted are the nail fold (A), dorsal roof (B), ventral floor (C), nail wall (D), perionychium (E), lunula (F), nail bed (G), germinal matrix (H), sterile matrix (I), nail plate (J), hyponychium (K), distal groove (L), fascial septa (M), fat pad (N), distal interphalangeal joint (O), and extensor tendon insertion (P).

The nail or nail plate lies immediately on top of the nail bed, which consists of 2 portions involved in the production, migration, and maintenance of the nail. The proximal portion, called the germinal matrix, contains active cells that are responsible for generating new nail. Damage to the germinal matrix results in malformed nails. The distal portion, the sterile matrix, adds thickness, bulk, and strength to the nail. The white crescent-shaped opacity at the proximal end of the nail is the lunula, which is the visible portion of the germinal matrix. The whiteness of the lunula is due to the poor vascularity of the germinal matrix. The nail arises from a mild proximal depression called the nail fold. The nail divides the nail fold into 2 components: the dorsal roof and the ventral floor, both of which contain germinal matrices. The skin overlying the nail fold is called the nail wall.

The nail bed receives its blood supply from the 2 terminal branches of the volar digital artery. A fine network in the proximal nail bed and in the skin proximal to the nail fold of the finger provides venous drainage. Lymphatic drainage follows a course similar to that of the venous network. The lymphatic network is dense in the nail bed, especially in the hyponychium. Innervation is derived from the trifurcation of the dorsal branch of the volar digital nerve. One branch goes to the nail fold, one to the pulp, and one to the distal tip of the finger.

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Epidemiology

Frequency

United States

Paronychia is the most commonly encountered hand infection, representing approximately 35% of all infections of the hand. Susceptible people include those whose occupations require them to have their hands in prolonged contact with water; such persons include bartenders, florists, bakers, and homemakers. In addition, individuals who are immunocompromised, such as those with HIV infection or those undergoing steroid therapy, are predisposed to paronychia.

Mortality/Morbidity

The motion of the affected finger may be limited in acute cases.

Race

No racial predilection is reported.

Sex

Paronychia is more common in women than in men, with a female-to-male ratio of 3:1.

Age

Paronychia may occur in patients of all ages.

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Contributor Information and Disclosures
Author

Allison Vidimos, MD, RPh  Staff, Section of Micrographic Surgery (Mohs) and Oncology; Chairman, Department of Dermatology; Cleveland Clinic

Allison Vidimos, MD, RPh is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth M Billingsley, MD  Professor of Dermatology, Penn State University College of Medicine; Director, Dermatologic Surgery and Mohs Micrographic Surgery, Penn State Hersey Medical Center

Elizabeth M Billingsley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, Association of Professors of Dermatology, Council for Nail Disorders, and Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard K Scher, MD  Professor of Dermatology, University of North Carolina

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Cryosurgery, American College of Physicians, American Dermatological Association, American Geriatrics Society, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, New York Academy of Sciences, Noah Worcester Dermatological Society, Rhode Island Medical Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Julia R Nunley, MD  Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society

Disclosure: Novartis Grant/research funds Consulting; Biolex Grant/research funds sub-investigator

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Depicted are the nail fold (A), dorsal roof (B), ventral floor (C), nail wall (D), perionychium (E), lunula (F), nail bed (G), germinal matrix (H), sterile matrix (I), nail plate (J), hyponychium (K), distal groove (L), fascial septa (M), fat pad (N), distal interphalangeal joint (O), and extensor tendon insertion (P).
Typical appearance of paronychia.
Simple acute paronychia can be drained by elevating the eponychial fold from the nail with a small blunt instrument such as a metal probe or elevator.
 
 
 
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