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Paronychia (Nail Infection) and how to deal with it

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Paronychia, an infection that affects the skin around the nail, can affect one’s quality of life, as it causes discomfort and pain. Experts warned that if left untreated, it could lead to complications.

Dr. Shakira Gold-Olufadi, Consultant Physician and Dermatologist, University College Hospital (UCH), Ibadan, said paronychia refers to an infection around the tissue surrounding the nail, and which often begins around the nail fold. It affects the fingernails more often than the toenails. 

She said: “To understand paronychia better, it is important to understand the structure of the nail shown in this picture. The nail is protected on both sides by the nail folds and the cuticle just below. Anything that causes damage to these areas exposes the tissues around the nails to invasion by microorganisms. These microorganisms may be fungal or bacteria. 

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According to the dermatologist, there are two types of paronychia: Acute and chronic paronychia. Acute paronychia is usually caused by bacteria, especially staphylococcus, streptococcus or pseudomonas and often presents dramatically with intense pain, swelling, and redness around the nail. There may be a collection of pus around the nails, and it may later involve deeper layers and become an abscess.

She continues: “Chronic paronychia, on the other hand, presents over a longer period in a less intense way, with minimal or no pain and slight swelling around the nails. There may be associated with nail infection and discoloration. Fungi called Candida species often cause it.

Gold-Olufadi explained that there are several risk factors for paronychia, which include nail biting, finger sucking, people who do manicure and pedicure that yank off their cuticles (Never allow them take off your cuticles or nail folds), regular use of nail glue, occupations that involve putting hands in water for a long time like housekeeping, washing and swimming instructors, among others.

She said: “Immune suppression from such diseases as HIV, malignancies, long-term use of drugs like steroids and some certain diseases like diabetes mellitus and excessive sweating (called hyperhidrosis) are also predisposing factors.

“The diagnosis of paronychia is usually clinical, supported by laboratory tests to assess the presence of bacteria or fungi, depending on whether it is acute or chronic.

On how to manage paronychia, the expert said, “Management depends on the type and severity. For mild ones, mild rinses with saline or warm compresses with use of analgesics may suffice. Once there is a collection, especially in the case of acute paronychia, surgical drainage becomes necessary, together with the use of appropriate antibiotics. For chronic paronychia, antifungals would be needed for treatment and for the appropriate duration. 

“It is also important to counsel the patients to avoid work that involves immersing their hands in water (wet work) and to use protective latex free gloves if they have to do wet work. It is also important to stop all other harmful practices like nail biting, nail glue use and most importantly, please leave your nail folds and cuticles alone.”

She explained that individuals with recurrent paronychia would need long-term monitoring and follow up. “They also need to be counseled on the need to avoid all the risk factors mentioned earlier, which may put them at risk of recurrence. Any identifiable cause of immune suppression should be addressed,” she said.

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