Chronic Paronychia: A Rundown Of The Fingernail Infection

Dermatology Clinic, Dermatologist in Singapore

You have access to the important clues about your overall health right at your fingertips. More than mere ornamental structures, nails are actually vital indicators of your health and serve as shields that protect the tissue beneath from possible infection via the things you touch every day. Made from a tough protein that is otherwise known as keratin, nails are typically strong and durable.

It is not to say that nails are invincible, however. Nail diseases such as chronic paronychia do occur, especially when it is one of the most common infections of the hand.

Structure Of the Nail

As with any biological structure, the morphology of a nail is complex. A single nail is comprised of 5 major cutaneous structures: nail matrix, nail plate, nail bed, cuticle and nail folds.

The nail bed consists of 2 primary portions: the proximal portion (also known as the germinal matrix) that carries active cells that are responsible for the nail’s growth, and the distal portion (also known as the sterile matrix) that adds strength, thickness and bulk to the nail. The nail fold also has 2 components of its own: dorsal roof and ventral floor. The cuticle is an outgrowth of the proximal nail fold and acts as the component that glues the skin of the digit and nail plate together.

These structures serve as a waterproof seal that protects the nail bed from external allergens, irritants and pathogens. Should any of these be damaged or broken, an avenue will be created by which irritants could enter and thus, increasing the risk of paronychia.

Introduction To Chronic Paronychia

Also known as whitlow, paronychia is an inflammation of the skin around the finger or toenail and is characterised by redness, tenderness and swelling. Caused by either a direct or indirect trauma to the cuticle or nail fold, the bacteria inoculation of the nail will result in inflammation and infection.

Whilst paronychia itself is not critical, recurrent acute paronychia can easily develop into chronic paronychia, a deeper infection that will need the help of a dermatology specialist.

Etiology Of Chronic Paronychia

Characterised by redness and swelling of the nail folds, chronic paronychia is often associated with fluid under the skin and a thickened nail plate with discolouration.

Morphologically, this nail disease also features the induration (localised hardening of soft tissue) and the rounding off of the paronychium (the soft tissue that surrounds the border of the finger and toenail). Recurring episodes of acute eponychial inflammation and drainage are also present.

Due to the inflammation of the nail matrix, other complexities may also surface. These may include:

Hypertrophy: The increase in the size of tissues in response to stimuli.
Onychomadesis: Proximal separation of the nail plate from the nail matrix due to a temporary cessation of nail growth.
Transverse striations: Tissue marked by transverse dark and light bands.
Pitting: Tiny dents in the nails.

The repeated bouts of induration, inflammation and fibrosis (development of fibrous connective tissue as a response to injury and damage) can temporarily cease nail growth and cause the nail folds to round up and retract. This only further exposes the nail grooves to moisture, irritants, allergens and pathogens in the external environment.

If not dealt with properly, the bacteria inoculation and acute flare-ups will exacerbate with time, drastically reducing the effectiveness of topical drugs as it progresses.

Diagnosis And Differential Diagnosis

The red, swollen nail folds are characteristics that are indicative of chronic paronychia, and doctors can typically make the diagnosis based on appearance alone without the aid of laboratory tests. Chronic paronychia needs to be present for at least 6 weeks prior to the diagnosis, with recurrent yet self-limited episodes of acute exacerbation.

That said, it is worth noting that other conditions also possess similar visual attributes; for instance, Reiter syndrome, psoriasis and eczema also cause proximal nail fold swelling, ridging and discolouration of the nails.

Differential diagnosis is also advisable as to rule out these conditions. The possibility of carcinoma should also be taken into consideration if the inflammation and infection are not responsive to treatments, and should that be the case, biopsy should be taken into consideration.

Treatment Options

Since the main causes of its pathogenesis are moisture and contact irritants, the affected area should be kept dry whenever possible. On top of avoiding the aggravating factors entirely, basic nail maintenance should be observed, and any manipulation of the nail such as manicures and any self-attempt to incise and drain the fluid should be avoided. Protection against unnecessary damage to the nail is also advised, thus be sure to use either rubber gloves or durable footwear whilst performing work.

To heal the affected area, you can either opt for the medical or surgical management approaches, with the latter reserved for chronic recalcitrant cases. Look out for topical steroid creams with tacrolimus or betamethasone 17-valerate 0.1%. If topical creams have little to no effect on the affected area, you may need to opt for the surgical removal of the inflamed tissue. Not only will it help with the mitigation of the exacerbation of the disease, but it will also help to aid with the penetration of the topical creams or oral drugs that would have otherwise be ineffective.

Whilst treatment and healing typically take several weeks to heal, the skin and nail will usually return to normal once proper treatment and medication are prescribed. Diligent application of the medication and keeping the affected area dry will ensure a fast and smooth recovery.

Key Takeaway

Apart from losing their aesthetic and cosmetic functions, those that suffer from chronic paronychia will experience discomfort and pain that will only aggravate and exacerbate as the inflammation and infection get worse. As such, it is wise to consult a dermatologist in Singapore for the appropriate treatment before your symptoms worsen.

At Angeline Yong Dermatology, we employ a comprehensive repertoire of innovative dermatological solutions with Dr Yong’s signature personalised care to deliver only the best results tailored to you.

Armed with over 15 years of medical experience, Dr Yong is a dermatologist and dermatological surgeon whose clinical interest is in hair and nail disorders. She is also trained in Cosmetic and Procedural Dermatology, making her the go-to dermatologist for your nail care needs.

If you’ve noticed redness and swelling or are experiencing discomfort in your nails, our dermatology clinic is only a phone call away!

References
1. Relhan, V., Goel, K., Bansal, S., & Garg, V. K. (2014). Management of chronic paronychia. Indian journal of Dermatology, 59(1), 15.

2.Rigopoulos, D., Larios, G., Gregoriou, S., & Alevizos, A. (2008). Acute and chronic paronychia. American family physician, 77(3), 339-346.

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Chronic Paronychia: A Rundown Of The Fingernail Infection