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SUMMARY
Paronychia is an inflammation involving the proximal and lateral nail folds.
It can be acute or chronic.
Chronic paronychia is a multifactorial reaction of the nail folds usually due to repeated exposure to allergen or irritants.
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TIPS FOR DIAGNOSIS
Most common clinical features are periungual erythema, swelling, absence of cuticle, and onychodystrophy.
The diagnosis is clinical; rare cases require nail biopsy.
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DON’T FORGET
Chronic paronychia is not a variety of onychomycosis.
It usually affects fingernails.
Females are more affected than males.
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PITFALLS AND CAUTIONS
It can also be an unusual sign of systemic disease or drugs.
The periungual folds induce the alteration of the nail plate due to inflammation of the nail matrix.
Differential diagnosis can be extremely challenging.
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Paronychia is an inflammation involving the proximal and lateral nail folds. It may be acute or chronic.
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Chronic paronychia is a multifactorial reaction of the nail folds, usually due to repeated exposure to allergens or irritants, followed by secondary fungal or bacterial colonization.1,2 It usually affects fingernails; toenail involvement is rare.3 Chronic paronychia may also be associated with inflammatory skin diseases such as atopic dermatitis and psoriasis and other dermatologic disease, like pemphigus vulgaris, which can mimic paronychia.4 Moreover, several drugs are associated with chronic paronychia occurrence.5–7
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The most common clinical features are periungual erythema, swelling, absence of cuticles, and onychodystrophy.
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Treatment should stop the source of irritation and treat the inflammation with topical steroids. A surgical approach is useful with a patient that failed to respond to medical treatment.8,9
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The correct incidence of chronic paronychia is not clearly known because lots of cases are not correctly diagnosed. Paronychia is more common in women than in men, with a female-to-male ratio of 3 to 1.10 It is common in those who are exposed to nail cuticle trauma and frequent immersion in water (cooks, dishwashers, and housecleaners).1,8
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Chronic paronychia is an inflammatory dermatosis involving one or more of the three nail folds. It is usually due to irritant dermatitis. Most common irritants include acids, alkalis, or other chemicals generally used by housekeepers, dishwashers, bartenders, laundry workers, florists, bakers, and swimmers. Also, excessive moisture, excessive manicuring, nail biting, ingrown nails, and thumb sucking can lead to chronic paronychia.1,4 Once the protective nail ...