By Gary M. White, MD
This grew out Candida.
The skin about the nail is inflamed and tender acutely. By definition, the condition is recent, as opposed to chronic paronychia. Pus may be seen. Infection by Staphylococcus is usually found. If involving the proximal nail fold, the nail may ultimately fall off. (Hopefully it will regrow normally.)
In a study of antibiotic-resistant acute paronychia [JAAD Jan 2014], the following diagnoses were found:
Common risk factors included finger- or thumb-sucking, nail-biting, contact with animals, frequent hand washing, immunosuppression, playing with water, ripping the hangnail, trauma, and prolonged use of antibiotics.
Inquiry should be made as to whether the patient is manipulating the cuticle. S/he should be told that the cuticle is an important "seal" between the nail and the skin and destroying this seal allows bacteria to enter and infect. Thus, no manicures please and no manipulating the cuticle. The patient should avoid prolonged water contact with the hands, e.g., use gloves when doing the dishes. A culture should be performed if possible. Many times, the patients is able to express fluid/pus from the area of the cuticle. An oral antistaphylococcal antibiotic should be given initially. A topical antibiotic is an alternative. If antibacterial treatment fails, an oral antifungal (e.g., fluconazole) may be given, although Candida infection is more common in chronic paronychia. A topical agent that has broad spectrum activity is 4% thymol in alcohol applied to the tissue about the nail BID.
A patient on isotretinoin with a Staph paronychia and a pyogenic granuloma.
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