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Chronic Paronychia

By Wingfield E. Rehmus, MD, MPH, Clinical Assistant Professor of Pediatrics, Associate Member of Department of Dermatology;, University of British Columbia;BC Children’s Hospital, Division of Dermatology

Chronic paronychia is recurring or persistent inflammation of the nail fold, typically of the fingernails.

Chronic paronychia occurs almost always in people whose hands are chronically wet (for example, dishwashers, bartenders, and housekeepers), particularly if they have hand eczema, diabetes, or an impaired immune system. The yeast Candida is often present, but its role in causing chronic paronychia is unclear because eliminating the yeast completely does not always cure the condition. Chronic paronychia may be the result of an irritant skin inflammation (dermatitis—see Overview of Dermatitis) in addition to colonization with Candida.

The nail fold (the fold of hard skin at the sides of the nail plate where the nail and skin meet) is painful and red as in acute paronychia (see Acute Paronychia), but pus usually does not accumulate. Often there is loss of the cuticle (the skin at the base of the nail) and separation of the nail fold from the nail plate (the hard part of the nail). A space then forms that allows irritants and microorganisms to enter. The nail can become distorted.

The doctor makes the diagnosis by examining the affected finger.

Keeping the hands dry and protected can help the cuticle re-form and close the space between the nail fold and nail plate. Gloves or barrier creams are used if water contact is necessary. Corticosteroid creams applied to the nail may be helpful. Tacrolimus may also be given. Antifungal treatments are not always helpful or necessary. Applying a solution of thymol in ethanol several times a day to the space formed by loss of the cuticle helps keep the space dry and free of microorganisms.

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