Paronychia

What is Paronychia?

Paronychia is either classify as bacterial or fungal infection that infect the fingernails and toenails. The usual type of fungi that infested the nail is the Candida; it is a genus of yeasts and is the most common cause of fungal infections worldwide.

The Candida causes chronic condition to the fingernail and/ or toenail while for the bacterial infection it is caused by staphylococci and sometimes mixed with aerobic and anaerobic flora.

Depending on the causative factor of the infection, paronychia can come slowly and gradually last for weeks. The symptoms can be easily observed and easily get treated with less harm on to your skin and nails.

Who often gets Paronychia?

Paronychia can infect anyone but the most of the listed people below are susceptible for this kind of infection;

People who has poor circulation
Bar tenders
Dairy farmers
Fishermen
Cleaners
Housewives

These people are prone of Paronychia mainly because their hands are constantly get exposed to wet and cold condition during their daily activities. But in many case as well, paronychia is mostly occurring to person with hand dermatitis.

Hand dermatitis also known as eczema, is a group of diseases that results in inflammation of the skin. For instance, irritant dermatitis frequently occurs on the hands of people who normally get them wet.

According to Medscape, the epidemiology rate of paronychia infection in the United States is represents 35% of these disorders. Mostly it is observed in women than men. The female to male ratio is 3:1.

In addition, the site where the infection mostly occurs is on the right hand than left hand, Pubmed said. The study also shows that the common fingers that were frequently affected were the right thumb having the percentage of 62% of infestation, followed by the right middle finger with 52%, left thumb finger with 57.6% and lastly the left middle finger with 51.5% infestation.

Causes

Since we already know that Paronychia is caused by bacteria and fungi, therefore determining their main causative and external factor will expound the detail of the occurrence of the infection.

Studies claim that acne medication of isotretinoin has caused paronychia to develop in patients.
Paronychia can occur due to an injury to a nail
Nail biting also another factor that cause paronychia, wherein biting your fingernails can lead to sore and bleeding of the fingertips resulting to an invitation to foreign pathogens such as bacteria and fungi to enter and invade your skin and nails.
When nails are exposed to harsh chemicals for a long period of time.
Hands that submerged in the water for a long period of time can also lead to Paronychia. As for the reason of the moisture which allows certain germs like candida and bacteria to thrive on the crevices of the nails or of the skin. A person whose hands may be wet for long periods of time has the greater risk for chronic paronychia.

Types

There are two different types of paronychia; Acute and Chronic Paronychia

1. Acute Paronychia

Infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting less than six weeks
It starts in the Paronychium at the side of the nail accompanied by redness, swelling and pain.
Excruciating pain and pus-filled condition; most frequently caused by staphylococci
Possible caused is due to direct or indirect trauma to the cuticle (nail fold) that may come from minor activities such as dishwashing, nail biting, picking at a hangnail, injury, finger sucking, ingrown nail or manicure procedure.
Mostly caused by bacteria such as;
- Staphylococcus aureus –
- Streptococcus species
- Pseudomonas species
- Gram-negative bacteria
- Anaerobic bacteria
- Fusarium species

2. Chronic Paronychia

Gradual occurrence
A nail disease prevalent for all individuals whose hands and or feet are exposed to moist local environments. Sometimes also caused by contact dermatitis
It starts from one fold but eventually spreads to other folds of the finger or nails accompanied by swollen and lifted off of the nail plate.
Infected skin sometimes red and tender from time to time and will develop eventually develop little pus (white, green or yellow) under the cuticle.
When the cuticle separates from the nail plate, it leaves a region between proximal nail fold and the nail plate to become susceptible for infection.
Mainly caused by the fungi Candida Albicans
Mostly caused some complications of the disease such as;
- Metastatic Cancer
- Subungual Cancer
- Squamous cell carcinoma
- Raynaud disease
- HIV (Human Immunodeficiency Syndrome)
- Diabetes
- Psoriasis

Signs & Symptoms

The acute paronychia typically affects one nail. It can be described by rapid onset erythema (reddening of the skin), edema (swollen), discomfort or tenderness of the center and lateral nail folds. While the chronic paronychia causes less symptoms compare with acute paronychia. Usually, the site around the nail is tender, erythema and edema are present as well, the cuticle is missing and the skin around the nail feels moist.

The general sings for both types of Paronychia are;

Redness or erythema around the nail
Tenderness or edema of the skin
Manifestation of pus-filled blisters on the infected site
Gradual changes in nail in terms of shape, color and texture
Nail detachment from the skin

Diagnosis

In diagnosing the Paronychia, some laboratory testing are need to consider in order to prescribed a specific drug to invade the specific bacteria or fungi that causes the infection and these include;

1.Swab for Gram stain, culture and sensitivity

According to epocrates.com, a clinical diagnosis of pus filled infection in the nail folds can be determined by performing Gram staining, culturing and sensitivity, optimally after draining the infection under sterile condition.

Such that case, the collection sample is subject for swabbed testing and culturing to accurately determine if what specific bacteria present in the infection. Commonly bacteria found on the onset of the infection are Staphylococcus aureus, Streptococcus species, and Pseudomonas species.

MRSA or Methicillin-resistant Staphylococcus aureus is suspected as well in all cases when individual has acute paronychia. Since MRSA is a form of bacterial infection that is resistant to numerous antibiotics including methicillin. It can be spread via contact to infected person whether by touching each other or touching the objects that have the bacteria on them. Therefore, culture should be obtained in every case.

2.KOH or Fungal culture

Commonly test for Candida albicans. Sometimes it is also known as potassium hydroxide or KOH prep. This is a laboratory fungal testing to distinguish dermatophytes and Candida albicans symptoms from other skin disorders such as psoriasis and eczema.

3.X-ray & MRI

It helps to detect bone disorder like osteomyelitis (an infection of the bone caused by staphylococcus aureus) or mass in an underlying bone disorder.

4.Biopsy of skin bone

It may rule out or confirm malignancy. The procedure performs by scraping a tiny sample of bone taken from the body and observed under microscope to investigate for possible carcinoma, infection or other bone disorders.

Treatment

The treatment for paronychia is quite effective with most people responding well when treated early. Some listed home remedies and general remedy for paronychia can alleviate the infection caused by bacteria and fungi.

1. Drug Medication

If the doctor diagnosed the paronychia is caused by bacteria then he or she will prescribed antibiotic. Some antibiotics used by health professional are Flucloxacillin or erythromycin. In minor cases of infection, an antibiotic cream like fusidic acid cream can be prescribed by your doctor. Note: if the antibiotic prescribed by your doctor does not shown any improvement after taking it for few days then seek immediate advice to your doctor.

2. Incision of Infected Skin

Draining out the pus out from the infected skin or nail can alleviate pain as well as the eradicating the bacteria that causing the infection.

3. Intake of Pain killers & Warm Bathing

This technique will help to lessen the pain and kills the germ on the infected site of your nail or skin. Simply soak the affected finger in warm salted water for four times a day or you may try to take paracetamol or ibuforen to ease the pain.

4. Other General Management Treatment

Keep your hand warm and dry.
Avoid exposing your skin or hand in cold or wet condition.
Stay away from some irritants such as heavy chemicals like soaps and detergents that can cause skin infection
Avoid yourself to get injury, finger sucking and nail biting etc.
Steroids creams (hydrocortisone or betamethasone) can help to alleviate the inflammation of the infection
Try using antifungal creams such as clotrimazole, miconazole or terbinafine
For antifungal tablets you may try taking terbinafine or itraconazole

References