1 August 2020 Author : Teresa Santos Paronychia a suppurative inflammation (sometimes with pus formation), of the skin and soft tissues of the fingers or toes. Most often it is located on the distal phalanx in the periungual region (around the nail). The most frequent cause of paronychia is a bacterial infection due to the proliferation of microorganisms that are naturally present in the skin, such as species of Staphylococcus and Streptococcus . Any trauma that causes an injury to the physical barrier that is the skin, allows bacteria to enter the deeper tissues. It is important to distinguish between bacterial paronychia, which is the most common and which is the subject of this article, from paronychia caused by the herpes virus that, therefore, has a viral cause. This paronychia caused by the herpes virus is common in children and its treatment is different from paronychia of bacterial origin. Evolution, signs and symptoms Paronychia can be: Acute, when the inflammation appears quickly after the trauma, the evolution is rapid and the problem settles in 1 or 2 days; Chronic, when there is a persistent inflammatory response to repeated exposure to trauma or irritating substances, it usually lasts for more than 6 weeks. In the acute form of the paronychia, although there may be some variations, the presentation usually includes erythema (redness), pain and local swelling. An abscess can form (collection of pus) and in more advanced stages the infection can reach the joint and bone structures. In the chronic form, inflammatory signs and pain are less evident and abscess formation is more rare. An associated yeast infection often occurs. What are the risk factors for developing a paronychia? Onychophagia (biting your nails); Professions that involve a lot of contact with water and chemicals (detergents); Removal of the nail plate (when doing the nails); Repeated trauma in the periungual region (region around the nail); Diabetes; Peripheral venous insufficiency. Panorychia treatment Acute paronychia The treatment depends on the degree of the affected tissues. In the early stages, when only pain, erythema and inflammation are present, treatment with hot compresses three to four times a day and topical antibiotics is sufficient in most cases. With the appearance of pus / abscess, drainage is indicated, performed by a physician and topical or oral antibiotics, if necessary, as indicated by the physician. In the most severe cases, when the deepest tissues are affected, more comprehensive surgical approaches and intravenous antibiotics may be necessary. Chronic paronychia In chronic forms, the main treatment is to avoid the mechanism of continued trauma. Topical treatment with corticosteroids (if there is no infection), antibacterials or antifungals (in case of overinfection) may be indicated. Prevention of paronychia recurrence After the first episode of paronychia the prevention of recurrence is very important, trying to keep nails always clean, dry and short. Repeated trauma and cuticle removal should be avoided and gloves should be used when contact with water and detergents is continuous. Recommendations If you think you have a paronychia, consult physician as soon as possible and do not start any type of pharmacological treatment (with drugs) without medical advice. Meet the general surgery team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
