Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens which has been present for at least 6 weeks at the time of diagnosis.
What are the symptoms?
• One or several fingernails are usually affected,
• Sudden pain, redness like acute paronychia
• Pus discharge
• Retraction of the proximal nail fold and absence of the adjacent cuticle.
• The nail plate becomes thickened and discolored, with transverse ridges.
• Nail loss.
What is the cause for this infection?
The cuticle separates from the nail plate, leaving the region between the proximal nail fold and the nail plate vulnerable to infection.
Who are all prone to get this problem?
• Laundry workers,
• House and office cleaners,
• Food handlers, cooks, dishwashers, bartenders,
• Chefs,
• Fishmongers, confectioners,
• Nurses,
• Swimmers.
What is the common organism thought to cause this infection?
• Candida albicans (controversial)
How to prevent?
• Apply moisturizing lotion after hand washing.
• Avoid chronic prolonged exposure to contact irritants and moisture (including detergent and soap)
• Avoid finger sucking.
• Keep nails short.
• Use rubber gloves, preferably with inner cotton glove or cotton liners.
What is the treatment?
• Steroids and Antifungal agent (ointment) used to treat and prevent recurrence.
• In severe cases- Oral antifungal and/or Steroids.
What are the options for non responders?
• Simultaneous total or partial avulsion of the nail plate.
• En bloc excision of the proximal nail fold is effective.
• Eponychial marsupialization, with or without nail removal.
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