Paronychia in Emergency Medicine 

  • Author: Heather Murphy-Lavoie, MD, FAAEM; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Oct 20, 2010
 

Background

A paronychia is a superficial infection of epithelium lateral to the nail plate. The acute painful purulent infection is most frequently caused by staphylococci but commonly has mixed aerobic and anaerobic flora.[1] The patient's condition and discomfort are markedly improved by a simple drainage procedure. Chronic paronychial infections also occur, but these are usually fungal rather than bacterial in nature. This discussion focuses on acute paronychial infections.

Paronychia is shown in the images below.

Paronychial erythema and edema with associated pusParonychial erythema and edema with associated pustule. This suggests a bacterial etiology. Paronychia, side view. Paronychia, side view.
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Pathophysiology

A paronychial infection usually starts in the lateral nail fold. Cracks, fissures, or trauma to the nail fold allows bacterial entry through the skin barrier.[2] Patients at risk include those with dyshidrotic eczema, contact dermatitis, and those with chronic dry, chaffed, or irritated skin such as dishwashers, florists, gardeners or housekeepers. Occasionally, the infection includes the complete margin of skin around the nail plate. It results from mechanical separation of the nail plate from the perionychium. Early in the course of this disease process (< 24 h), cellulitis alone may be present. An abscess can form if the infection does not resolve quickly.

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Epidemiology

Frequency

United States

Paronychia is the most common infection of the hand representing 35% of all hand infections in the United States.[3]

Mortality/Morbidity

Failure to properly treat a paronychia can result in hand infection and, occasionally, systemic infection from hematogenous extension.

  • The abscess initially forms on the lateral nail fold. It can spread to the eponychium, eventually forming a "horseshoe" that includes the opposite nail fold.
  • It may spread to the pulp space of the finger, creating a felon.
  • An untreated infection can spread to the deep spaces of the hand and beyond.[4]

Sex

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

Age

No predilection exists.

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Contributor Information and Disclosures
Author

Heather Murphy-Lavoie, MD, FAAEM  Assistant Professor, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine, New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Micelle J Haydel, MD  Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center

Micelle J Haydel, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Sigma Theta Tau International, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerome FX Naradzay, MD, FACEP  Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

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  5. Dahdah MJ, Scher RK. Nail diseases related to nail cosmetics. Dermatol Clin. Apr 2006;24(2):233-9, vii. [Medline].

  6. Colson AE, Sax PE, Keller MJ, et al. Paronychia in association with indinavir treatment. Clin Infect Dis. Jan 2001;32(1):140-3. [Medline].

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  9. Tomková H, Kohoutek M, Zábojníková M, Pospísková M, Ostrízková L, Gharibyar M. Cetuximab-induced cutaneous toxicity. J Eur Acad Dermatol Venereol. Jun 2010;24(6):692-6. [Medline].

  10. Osio A, Mateus C, Soria JC, et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br J Dermatol. Sep 2009;161(3):515-21. [Medline].

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  12. Rigopoulos D, Gregoriou S, Belyayeva Y, Larios G, Gkouvi A, Katsambas A. Acute paronychia caused by lapatinib therapy. Clin Exp Dermatol. Jan 2009;34(1):94-5. [Medline].

  13. Kapellen TM, Galler A, Kiess W. Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes mellitus than in non-diabetic peers. J Pediatr Endocrinol Metab. Jun 2003;16(5):751-8. [Medline].

  14. Tosti A, Piraccini BM, D'Antuono A, Marzaduri S, Bettoli V. Paronychia associated with antiretroviral therapy. Br J Dermatol. Jun 1999;140(6):1165-8. [Medline].

  15. Yip KM, Lam SL, Shee BW, Shun CT, Yang RS. Subungual squamous cell carcinoma: report of 2 cases. J Formos Med Assoc. Aug 2000;99(8):646-9. [Medline].

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  17. Jules KT, Bonar PL. Nail infections. Clin Podiatr Med Surg. Apr 1989;6(2):403-16. [Medline].

  18. Muniz AE, Evans T. Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis. J Emerg Med. Oct 2000;19(3):245-8. [Medline].

  19. Turkmen A, Warner RM, Page RE. Digital pressure test for paronychia. Br J Plast Surg. Jan 2004;57(1):93-4. [Medline].

  20. Riesbeck K. Paronychia due to Prevotella bivia that resulted in amputation: fast and correct bacteriological diagnosis is crucial. J Clin Microbiol. Oct 2003;41(10):4901-3. [Medline]. [Full Text].

  21. Daniel CR 3rd, Daniel MP, Daniel J, Sullivan S, Bell FE. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis. Jan 2004;73(1):81-5. [Medline].

  22. Fung V, Sainsbury DC, Seukeran DC, Allison KP. Squamous cell carcinoma of the finger masquerading as paronychia. J Plast Reconstr Aesthet Surg. Feb 2010;63(2):e191-2. [Medline].

  23. Engineer L, Norton LA, Ahmed AR. Nail involvement in pemphigus vulgaris. J Am Acad Dermatol. Sep 2000;43(3):529-35. [Medline].

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  25. Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin. Nov 1998;14(4):547-55, viii. [Medline].

 
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Paronychia incision and drainage.
Paronychial erythema and edema with associated pustule. This suggests a bacterial etiology.
Paronychia, side view.
After simple drainage, there is purulent return.
 
 
 
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