Toenail paronychia

Abstract

Paronychia is an inflammation of the tissues alongside the nail. It may be acute or chronic and can be seen in isolation or in association with an ingrowing toenail. Acute paronychial infections develop when a disruption occurs between the seal of the nail fold and the nail plate, providing a portal of entry for invading organisms. The treatment of paronychia associated with an ingrowing toenail is aimed at treating the causal toenail. In paronychia not associated with an ingrowing toenail, antibiotics may cure an early infection but surgical drainage of an abscess is often required. In this case, an intra-sulcal approach is preferable to a nail fold incision. Chronic paronychia is less common in the feet than in the hands. It is a form of contact dermatitis and is frequently non-infective, however the chronically irritated tissue may become secondarily colonised by fungi. A dermatology consultation should be obtained for suspected chronic paronychia. Patients with chronic paronychia that is unresponsive to standard treatment should be investigated for unusual causes, such as malignancy. An algorithm for the treatment of paronychia is presented in this review.

Imbalanced Dermic Microbiome Aggravates Inflammation in Toenail Paronychia

“…Paronychia refers to inflammation of the periungual folds that was previously recognized as being caused by aerobic microorganisms such as S. aureus and S. pyogene ( Duhard, 2014 ; Lomax et al., 2016 ). However, in the early 1980s, some case reports have indicated anaerobic bacteria as the key pathogens in the progression of inflammation in paronychia ( Whitehead et al., 1981 ; Brook, 1993 ).…”

“…Paronychia is one of the most common inflammatory diseases of the periungual folds, which arises as a result of ingrown nails (onychocryptosis), neglected wounds, dermatological conditions such as Reiter’s syndrome, and medications such as retinoids ( Rockwell, 2001 ; Duhard, 2014 ; Relhan et al., 2014 ; Lomax et al., 2016 ). Inadequate treatment can result in the transformation of the infection from a local disease (flexor tenosynovitis, osteitis, or osteoarthritis) to a systemic disease (endocarditis or bacterial translocation) ( Pierrart et al., 2016 ).…”

“…such as S. aureus and S. pyogene (Duhard, 2014;Lomax et al, 2016). However, in the early 1980s, some case reports have indicated anaerobic bacteria as the key pathogens in the progression of inflammation in paronychia (Whitehead et al, 1981;Brook, 1993).…”

Conservative management of a severe case of onychocryptosis at a podiatric clinic—A case report

“…1,3,7,9 For conservative management, a variety of techniques are available, including cotton wick packing, gutter or sleeve treatment (sulci protectors), advising the patient to change their choice of footwear, application of topical disinfectants, wound dressings and ointments, lateral oblique trimming of the nail and orthonyxia (toenail bracing). [4][5][6][7][8][9][10][11][12][13][14] The packing method involves placing a piece of cotton wick between the lateral nail fold and the edge of the nail to reduce pain and prevent inflammation by lifting the lateral edge of the nail plate and separating it from the wound. [4][5][6][7][8][9][10][11][12] The sleeve or gutter technique involves the application of the so-called sulci protectors, which are readymade silicone tubes varying in thickness, size, and color.…”

“…[4][5][6][7][8][9][10][11][12][13][14] The packing method involves placing a piece of cotton wick between the lateral nail fold and the edge of the nail to reduce pain and prevent inflammation by lifting the lateral edge of the nail plate and separating it from the wound. [4][5][6][7][8][9][10][11][12] The sleeve or gutter technique involves the application of the so-called sulci protectors, which are readymade silicone tubes varying in thickness, size, and color. They may be inserted on the edges of the nail plate to prevent them from digging into the nail folds, and are recommended to manage stages 1a and 1b of the condition, as well as to prevent wounds caused by pincer nail deformity.…”