(See also Overview of Nail Disorders Overview of Nail Disorders A variety of disorders can affect nails, including deformities, trauma, infections of the nail, paronychia, retronychia, and ingrown toenails. Nail changes may occur in many systemic conditions... read more .)
Chronic paronychia is an inflammatory disorder of the nail fold skin. It occurs most often 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 Contact Dermatitis Contact dermatitis is inflammation of the skin caused by direct contact with irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Symptoms include pruritus and... read more with secondary fungal colonization.
The nail fold may be red and tender with repeated bouts of inflammation and often becomes fibrotic. Unlike acute paronychia Acute Paronychia Paronychia is infection of the periungual tissues. Acute paronychia causes redness, warmth, and pain along the nail margin. Diagnosis is by inspection. Treatment is with antistaphylococcal antibiotics... read more , there is almost never pus accumulation. There is often loss of the cuticle and notable separation of the nail fold from the nail plate. This separation leaves a space that allows entry of irritants and microorganisms. The nail may become dystrophic over the long term.
Diagnosis of chronic paronychia is clinical.
Avoiding irritants and excessive water exposure
Topical corticosteroids or tacrolimus
Sometimes intralesional corticosteroids and antifungal drugs
For severe or refractory disease, surgery
Avoiding irritants and excessive water exposure helps the cuticle reform and 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). Intralesional corticosteroid injections in to the hypertrophic proximal nail fold may expedite improvement. Antifungal treatments are added to therapy only when fungal colonization is a concern.
Severe or refractory cases may require surgery (1 Treatment reference Chronic paronychia is recurrent or persistent nail fold inflammation, typically of the fingers. (See also Overview of Nail Disorders.) Chronic paronychia is an inflammatory disorder of the nail... read more ).
If there is no response to therapy and a single digit is affected, squamous cell carcinoma Squamous Cell Carcinoma Squamous cell carcinoma is a malignant tumor of epidermal keratinocytes that invades the dermis; this cancer usually occurs in sun-exposed areas. Local destruction may be extensive, and metastases... read more should be considered and a biopsy should be done.