(See also Acute Paronychia.)
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) in addition to the presence of Candida.
The nail fold (the fold of hard skin at the sides of the nail plate where the nail and skin meet) is painful, tender, and red as in 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 of chronic paronychia 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. Corticosteroids may also be injected into the nail fold. Tacrolimus cream may also be given.
Antifungal drugs (such as fluconazole taken by mouth) are given only if people are at risk of being colonized by Candida.
Surgery on the nail fold may be needed for people who have a severe disorder or whose disorder is hard to treat with other methods.
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