Paronychia is a common infection of the skin which is just next to a nail. It is an inflammatory disorder which affects the nail folds. It can last more than 6 weeks and may involve one or more of the three nail folds. The term is from Greek para, “around” and onukh-, “nail”.Paronychia is also sometimes called ‘whitlow’.
STRUCTURE OF NAILS
Nail consist of 5 main parts-
- Nail matrix
- Nail plate
- Nail bed
- Cuticle (Medical term- Eponychium)
- Nail folds
Nail bed consists of 2 portions. It is necessary for production, migration and maintenance of the nail. Its proximal portion which is called germinal matrix contains active cells which is responsible for generation of new nail. If this portion of nail is damaged then it may result in malformed nails. Distal portion is sterile matrix. It is necessary for thickness, bulk and strength to the nail. Nail which arises from a mild proximal depression is known as proximal nail fold.
Cuticle is an outgrowth of the proximal nail fold. It is situated between the skin of the digit and the nail plat. It helps to fuse these two structures together. It acts as a protective layer from external irritants, allergens and pathogens. This protection is damaged in chronic paronychia and results in infection.
- Presence of fluid in nail folds.
- Thick discoloured nail.
- Swelling of paronychium.
- Recurrent inflammation and drainage.
- Thickening of nail plate.
- Longitudinal lining on nails.
- Oncychomadesis (It is a periodic shedding of the nails beginning at the proximal end. It is caused by hand and mouth disease in children.)
- Green discoloration of lateral margins. It is due to Pseudomonas aeruginosa.
- Skin appears red and hot.
- Pus is present along with thickening and browning discoloration of the nail plate.
What happens in Paronychia?
Because of repeated inflammation, swelling and fibrosis nail folds become round and retract. Protective layer of nail is lost. So, there is persistent retention of moisture. If this micro-organism persists in nail they further multiply and infection spreads further. With time blood supply is lost.
In earlier times, it was believed that chronic paronychia is caused by Candida. But now it is said that it is an eczematous condition.
- House and office cleaners
- Laundry workers
- Food handlers
- Patient with diabetes
- Patients on HIV-ART
- Infections including Bacterial, mycobacterial or viral
- Raynaud’s disease
- Cancer which spread to other organs and in advanced stage
- People who wash dishes frequently
Use of drugs like retinoids, epidermal growth factor-receptor inhibitors (cetuximab), and protease inhibitors. Indinavir- induces retinoid-like effects and remains the most frequent cause of chronic paronychia in patients with HIV disease. Patients taking cetuximab (Erbitux), an anti-epidermal growth factor-receptor (EGFR) antibody used in the treatment of solid tumors.
It is said that acute paronychia is caused by use of popular acne medicine isotretinoin.
Prosector’s paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specimens for dissection.
Paronychia around the entire nail is sometimes referred to as runaround paronychia.
- By avoiding exposure to moist environment.
- Avoid exposure of contact irritants such as soaps and detergents.
- Affected area should be kept dry.
- Apply moisturizers after washing hands.
- Rubber gloves should be used, preferably with inner cotton glove or cotton liners while performing any work with probable exposure to irritants.
- Keep nail short.
- Avoid practices like manicuring, finger sucking or self attempt to incise.
- Choose proper footwear.
- Control blood glucose level.
- Do not bite your nails or pick at the skin next to nails.
- Dry well after washing. Wear rubber gloves (preferably cotton-lined) if you work a lot with water.
- Do not wear gloves or artificial nails for long periods.
Surgical Management Paronychia
Simple eponychial marsupialization:
Anaesthesia is given and tourniquet is applied. A crescent-shaped incision parallel and proximal to the distal edge of eponychium is done. This process helps in drainage of infected nail.
- Dairy farmers.
- Nail biting.
- Poor manicure technique – for example, pushing the cuticles back too far with a hard instrument.
- Damaged or diseased nails or nail folds – for example, from skin conditions such as eczema or contact dermatitis.
- In growing toe nails – the nail grows into the skin, breaking.
Homeopathic medicines of Paronychia
Antim Crud is helpful in treatment of fungus causing distorted nails and toenails. It is suited to a person who is very irritable and has thickly coated white tongue. His symptoms are worse by heat and cold bathing. He has tendency to grow fat. HE is very concerned about his fate. It can be given to children who cannot bear to be touched or looked at. It is given when nails are brittle and grow out fo hsape. It is very good remedy when patient has horny warts on hands and soles. Feet are very tender. It also cures pain in soles.
Dosage: 200,4pellets, 2 times for 10 days.
Silicea is very helpful for nail fungus with pus, infection and sharp pains in toenails. It is very good remedy for disease of bones caries and destruction of bones. It is given to person who has alcoholic stimulants. It is given to person who has faint:hearted and anxious. He has obstinate and headstrong children. It is given to patient who have affections of finger nails. It is given especially if white spots are present on the nails. It is very good remedy for ingrowing toe nails. Patient has icy cold and sweaty feet. Patient has suppurating sensation in finger tips.
Dosage: 6x, 4 pellets, 3 times a day for 2 months.
Graphites is given when patient has nail fungus when nails crack. It is given to person who has fair complexion with a tendency to skin disease and constipation. He is fat, chilly and constipated Patient has great tendency to start. Music makes her weep. It is given when toe nails are crippled. It can also be given when patient has stiffness and contraction of toes. His nails are brittle and breaks easily. It also treats when patient has deformed nails which are painful, sore, thick and crippled.
Dosage:30, 4 pellets, 2 times a day for 10 days.
Bufo rana is given when patient has nail Infection and fungus that turns the nail blue. It is suited to children who are weak minded. It is given to patient who is anxious about health. He is sad and restless. He desires for solitued. It is given when patient has pain in extremities. It is given when patient has fungal infections of the nails and toenail which appear bluish or blackish in colour. It is given when patient has swollen skin around the nails and has pus. It is associated with a deep dull pain that run upward till the armpit.
Dosage: 200, 4pellets, 2 times a day, 10 days.