(See also Overview of Nail Disorders.)
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 with secondary fungal colonization.
The nail fold may be red and tender with repeated bouts of inflammation and often becomes fibrotic. Unlike acute paronychia, 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 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).
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.
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