Derm Dx: Pain at the base of a fingernail - Clinical Advisor

Derm Dx: Pain at the base of a fingernail

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The patient is a 52-year-old woman who complains of pain at the base of a fingernail. The condition was first noted 3 days ago and initially drained pus. She admits to biting her cuticles and to having a similar condition approximately 1 year ago. Examination reveals swelling of the affected site, and light palpation elicits tenderness.

 

Paronychia is inflammation of 1 or more nailfolds located on the fingers or toes. Two forms are recognized based on duration: acute and chronic.1 Acute paronychia are most commonly induced by bacterial and/or candidal infection following breach of the protective...

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Paronychia is inflammation of 1 or more nailfolds located on the fingers or toes. Two forms are recognized based on duration: acute and chronic.1 Acute paronychia are most commonly induced by bacterial and/or candidal infection following breach of the protective nail and surrounding skin barrier. Many cases respond to warm or hot compresses. Drainage is indicated if purulence is noted. Oral antibiotics may be indicated if severely inflamed.

Paronychia are termed chronic if signs and symptoms last greater than 6 weeks. The condition is a manifestation of an irritant dermatitis. Common irritants include acidic and alkali chemicals encountered by those doing wet work such as housekeepers, beauticians, dishwashers, and bartenders. Cessation or limiting exposure is necessary to promote adequate healing. Topical steroids also help to minimize inflammation. Resolution may take several months.2

Systemic chemotherapy may induce paronychia with the most common agents being the taxanes (docetaxel, paclitaxel, nab-paclitaxel) and both classes of EGFR inhibitors.3 Paronychia may also arise during therapy with isotretinoin.4 Paronychia that persist may warrant work-up for an underlying neoplastic process.5

Dr Schleicher is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at the Commonwealth Medical College and a Clinical Instructor of dermatology at Arcadia University and Kings College.

References

  1. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. 2001;63:1113-1116.
  2. Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008;77:339-346.
  3. Capriotti K, Capriotti J, Pelletier J, Stewart K. Chemotherapy-associated paronychia treated with 2% povidone-iodine: a series of cases. Cancer Manag Res. 2017;9:225-228.
  4. Figueiras Dde A, Ramos TB, Marinho AK, Bezerra MS, Cauas RC. Paronychia and granulation tissue formation during treatment with isotretinoin. An Bras Dermatol. 2016;91:223-225.
  5. Lee CC, Wu YH. Paronychia-like digital metastases of osteosarcoma. Int J Dermatol. 2017;56:104-105.

 

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