Chronic Paronychia

By Chris G. Adigun, MD, Dermatology & Laser Center of Chapel Hill, Chapel Hill, NC

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Chronic paronychia is recurrent or persistent nail fold inflammation, typically of the fingers.

Chronic paronychia occurs almost always in people whose hands are chronically wet (eg, dishwashers, bartenders, housekeepers), particularly if they have hand eczema, are diabetic, or are immunocompromised. Candida is often present but its role in etiology is unclear; fungal eradication does not always resolve the condition. The condition may be an irritant dermatitis with secondary fungal colonization.

The nail fold is painful and red as in acute paronychia, but there is almost never pus accumulation. There is often loss of the cuticle and separation of the nail fold from the nail plate. This separation leaves a space that allows entry of irritants and microorganisms. The nail becomes distorted.

Diagnosis is clinical.

Treatment

Keeping hands dry
Topical corticosteroid or tacrolimus

Primary treatment is to keep the hands dry and to assist the cuticle in reforming to close the space between the nail fold and nail plate. Gloves or barrier creams are used if water contact is necessary. Topical drugs that may help include corticosteroids and tacrolimus 0.1% (a calcineurin inhibitor). Antifungal treatments are added to therapy only when fungal colonization is a concern. Thymol 3% in ethanol applied several times a day to the space left by loss of cuticle aids in keeping this space dry and free of microorganisms. If there is no response to therapy and a single digit is affected, squamous cell carcinoma should be considered and a biopsy should be done.

Last full review/revision February 2017 by Chris G. Adigun, MD