You can download this leaflet by clicking here

Patient Information Leaflet

Chronic Paronychia

What are the aims of this leaflet?

This leaflet has been written to help you understand more about chronic paronychia. It will tell you what it is, what causes it, what can be done about it, and where you can find out more about it. 

What is chronic paronychia?

Paronychia is a common infection of the skin around the fingernails (the nail folds). ‘Acute paronychia’ is the term used for short-lived episodes; ‘chronic paronychia’ is used if it lasts for more than 6 weeks. Often it grumbles on for months or even years. 

What causes chronic paronychia?

Chronic paronychia is not caught from someone else. The germs that cause it are known as ‘opportunistic pathogens’. This means that they can damage you only if they are given the chance, when a chink appears in the body’s defences.  In the case of chronic paronychia, this is often a split in a cuticle, which normally protects and seals off the potential space between the nail and the nail fold.

A swab from an infected nail fold will often grow a mixture of bacteria and yeasts in the laboratory, rather than just a single type. Some of these can discolour the nail. 

Women get chronic paronychia three times as often as men. It is particularly common in those who:

• have their hands constantly in water and detergents (for example housewives, bar staff and kitchen workers), or bakers who work with flour
• have a poor circulation, and therefore cold hands and feet
• push back their cuticles
• have diabetes
• have thrush elsewhere

Is chronic paronychia hereditary?

No.

What are the symptoms of chronic paronychia?

It causes repeated episodes of tenderness and swelling of the affected nail folds. The nails may also have a discoloured appearance and appear cosmetically unacceptable for some.

What does chronic paronychia look like?

It starts in the nail fold at the base of one nail, but often spreads up beside the nail. All nails in the hands can be affected.

The main changes are:

• areas of swelling at the base or sides of one or more nails. The skin becomes red, shiny and tender, and the nail folds separate away from the nail.
• loss of the cuticle in inflamed areas.
• pus - white, yellow or even greenish - can be squeezed out in small amounts from inflamed areas.
• the nail itself may grow out ridged and become discoloured. These changes can take up to a year to go away after the paronychia has cleared.

How is chronic paronychia diagnosed?

The red bolstered nail folds of chronic paronychia give it a characteristic look so your doctor will be able to make the diagnosis without laboratory tests. It should not be confused with a ringworm (tinea) infection, in which the nail itself, but not the nail folds, will be affected. 

It is worth:

• checking the urine for sugar to make sure you don’t have diabetes.
• taking a swab from an inflamed nail fold to see which germs are present as this may influence treatment.  

Can chronic paronychia be cured?

Yes - but remember that just as it starts slowly, it also clears slowly.

How can chronic paronychia be treated?

To work well, treatment has to alter the things that started it - and this is not always easy. It may take as long as six months for the cuticle to reform, and until it does, the problem may recur. Your own actions are of great importance here (see below under ‘What can I do?). In addition:

• apply an anti-yeast cream or lotion to the inflamed areas several times a day. Sometimes a steroid in the preparation speeds up a cure.
• if a swab shows that particular bacteria are playing a big part, your doctor will select a cream that works against them.
• in more severe cases, or if the local applications have not helped after a few weeks, it may be worth taking a course of anti-yeast tablets, or antibiotic tablets if the swabs suggest this.
• usually there is no need for surgery.
• underlying conditions such as diabetes, or thrush in other parts of the body, should be treated on their merits.

What can I do?

• You should keep your hands as warm and dry as possible; you will not get better until you do this. The use of waterproof gloves, always with cotton gloves inside, cuts down contact with detergents and water. 
• Avoid biting your nails and manicuring your nail folds.
• Occasionally a change of job is worth thinking about. 

Where can I get more information?

Web links to detailed leaflets:

www.aafp.org/afp/20010315/1113.html
www.docderm.com/patient_information/paronychia.htm
http://www.dermnetnz.org/fungal/paronychia.html

The British Skin Foundation fund vital research into all skin diseases.  To find out how you can help, please visit the British Skin Foundation website here.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor.

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED AUGUST 2004
UPDATED MARCH 2010