Paronychia refers to the inflammation of the tissues on both sides of the nail (toe) and around it, which is more common in frequent contact with water or washing materials, includingNail biting mania, too deliberate manicure, and inlay in the crowd.According to the cause and course of disease, paronychia can be divided into acute and chronicacute paronychia Bacterial infection usually occurs after minor trauma, andChronic paronychiaIt may be caused by candida infection or long-term repeated contact with irritants or mutants.
In terms of symptoms, paronychia is mainly manifested as redness, swelling and pain of the periungual tissue. In severe cases, it can produce suppuration, and pus will be discharged from the paronychia.In addition, chronic paronychia may meet the separation of perionychial skin and deck, as well as changes in nail morphology.
The doctor will choose appropriate drug treatment or surgical treatment according to the type of paronychia, the scope of inflammation and whether an abscess is formed.Common treatment methods include the use of antifungal drugs, oral or injectionantibioticFor severe cases, it may be necessary to cut and drain pus or infected parts.
TCM disease name
onychia lateralis
Foreign name
Paronychia
Visiting department
Dermatology, General Surgery, Endocrinology
Multiple population
Those who frequently contact with water or washing materials, nail biting, frequent finger sucking, excessive manicure, improper nail enhancement, and nail inlaying, as well as laundrymen, cleaners, food processors, cooks, dishwashers, fishmongers, and nurses
Common location
Periungual tissue of fingers or toes
Common causes
Minor skin trauma around the nail (such as tearing barbs, biting nails, sucking fingers, excessive manicure or ingrowing nails, etc.) causes damage to the normal skin barrier and secondary microbial infection, mainlybacterial infection
common symptom
The tissue around the nail is red, swollen, hot, painful, and can fester in severe cases
The main cause of acute paronychia is bacterial infection secondary to minor trauma to the nail bed, such as excessive manicure, biting barbs and other minor trauma, which destroys the normal skin barrier around the nail and causes bacteria (mainlyStaphylococcus aureus, also includesStreptococcus pyogenes、Pseudomonas aeruginosa、Proteus vulgarisAnd so on), leading to local infection.
Chronic paronychia
It may be related to long-term exposure to irritants or mutants, or it may beCandida albicansInfection.
High risk factors
High risk factors of finger paronychia
Nails are too deeply manicured.
Housewives, bartenders, barbers, cooks, swimmers, nurses and other people whose hands have been immersed in water or other chemicals for a long time.
Regular manicurists.
Children with bad habits of biting and sucking fingers.
High risk factors of toe paronychia
If you wear tight shoes for a long time, it is easy to form ingrown toenails under long-term pressure, which will damage the nail groove, and bacteria are easy to invade.
The feet are prone to sweat, and the feet are in a stuffy and wet environment for a long time.
In addition to the above factors,diabetesPeople with low immunity are prone to infection, thus inducing finger or toe paronychia.
symptom
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The main manifestations of paronychia are redness, swelling and pain of the periungual tissue. In severe cases, it can fester, and pus will be discharged from the paronychia.
Typical symptoms
The main manifestations of paronychia are redness, swelling, heat and pain, but different types and stages of paronychia have different characteristics.
acute paronychia
The disease develops rapidly. The initial symptoms are local redness, swelling, heat and pain of the finger (toe) nail. A few days later, it begins to fester, and there is a sense of waviness. If the inflammation continues to spread, it can form an abscess under the nail, causing purulent finger (toe) cephalitis.
Chronic paronychia
The degree of redness, swelling and pain of the patient is relatively mild, but the symptoms can also suddenly worsen.The skin around the nail and the deck will be separated, and changes in the shape of the nail will occur, such as bulges, grooves, discoloration, and hypertrophy of the deck.
Chronic paronychia can be divided into five different stages:
Stage I: Nail cuticle/proximal nail fold erythema and mild edema, with or without destruction of nail cuticle sealing state.
Stage II: erythema and significant edema of the proximal nail fold, accompanied by destruction of the closed state of the nail cuticle.
Stage III: erythema and edema of proximal nail fold, loss of nail cuticle, mild discomfort, early edema, mild deck change.
Stage IV: erythema and edema of proximal nail fold, loss of nail cuticle, tenderness/pain, edema, significant deck changes.
Phase V: Phase IV plus acute paroxysm of chronic paronychia (acute paronychia).
Medical treatment
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If the tissue around the finger (toe) nail of the patient has redness, pain and abscess, the patient needs to go to the dermatology department for medical treatment.Generally, diagnosis can be made through characteristic clinical manifestations.
If necessary, the doctor may suggest to carry out pus bacterial culture, fungal smear and fungal culture to identify pathogenic microorganisms.If chronic paronychia is considered to be related to exposure to the mutant, patch test is required.Some non infectious nail diseases with paronychia, such asAcrodermatitis continuaA pathological examination is required to confirm the diagnosis.
Indication for medical treatment
The tissue around the nail is red and swollen, and the pain lasts for 2-3 days, without improvement.
Abscesses form around or below the nail.
The redness and swelling around the nail are aggravated, accompanied by severe pain at the fingertip.
Diabetic patients have paronychia symptoms.
Diagnostic process
In case of redness, swelling, pain and other symptoms around the nail, the patient should go to the dermatology department for medical consultation in time.
The doctor will inquire about the patient's medical history.
Whether there is a history of minor trauma before the onset, such as barbs, too deep nail cutting, etc;
Specific occupation, such as chef, barber, bartender, nurse, etc;
Whether you have systemic diseases such as diabetes or skin diseases such as psoriasis;
History of drug use for associated diseases;
Whether you often wear airtight and tight shoes.
The doctor performed a physical examination on the patient to observe the skin condition around the nail and whether there was abscess formation.
The doctor may suggest the patient to carry out laboratory tests such as pus bacterial culture, fungal microscopy, fungal culture, patch test, etc. for further diagnosis.
After the diagnosis, the doctor will choose drug treatment, physical therapy, surgical treatment, etc. according to the type of paronychia, the scope of inflammation, whether the abscess is formed, etc.
Visiting department
When the patient has redness, pain and other symptoms in the tissues around the nail, the dermatology department should be considered first.
After the dermatologist has confirmed the diagnosis, some patients can go to general surgery for treatment when they need surgical incision and drainage or nail extraction.
Diabetics also need to go to the endocrine department for medical treatment.
Relevant inspection
Pus bacterial culture
For suppurators, doctors may conduct pus culture to identify pathogenic bacteria.Pyogenic bacteria can be cultivated in acute paronychia.
Direct microscopic inspection of blade
The doctor will scrape a small part of pathological tissue from the lesion and put it under a microscope for observation.Chronic paronychia caused by Candida albicans infection can be found in fungal spores, pseudohyphae, etc.
Fungal culture
Candida can be cultivated by taking pus or nail dust for fungal culture.
differential diagnosis
The clinical diagnosis of the disease is generally clear, and if there is a complex situation, it must be judged by the clinician according to the individual condition of the patient.
treatment
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After the diagnosis of paronychia, doctors will formulate different treatment plans, mainly including drug treatment and surgical treatment, according to the etiology and type of paronychia, the scope of inflammation, whether the abscess is formed, etc.
General treatment
For those with mild symptoms, soak the hands or feet with warm water for 3 to 4 times every day for 20 minutes each time.Hydrogen peroxide (1:1 solution) can be added to help reduce pain and swelling.
medication
Local external medication
For acute paronychia with slight inflammatory reaction but no abscess, aluminum acetate solution orChlorhexidine solutionrinse.
Antibiotics can be taken orally or injected intramuscularly at the initial stage of paronychia, but it is unnecessary to use them after full incision and drainage.
If the infection spreads to the surrounding tissues, systemic antibiotic treatment should be given, usually anti Gram positive staphylococcal antibiotics;If the pus culture test is performed, sensitive antibiotics can be selected according to the results of drug sensitivity in vitro.
surgical treatment
Abscess drainage and nail removal
Indications
It is applicable to acute paronychia with clear abscess formation, failure of conservative treatment or extensive inflammation involving nail cuticles.
Surgical methods
Incision and drainage of pus along the side of the nail groove.For the abscess at the nail root, it is necessary to pull out part or even the whole finger (toe) nail.However, the nail removal trauma is large, the nail bed exposure time is long, the pain is obvious, and the new finger (toe) nail is easy to deform, so it is easy to relapse.
Preoperative care
Carry out routine blood test and blood coagulation function test according to the doctor's instructions.Patients with hypertension, heart disease and diabetes should inform the doctor in advance, and the operation can only be carried out after the blood pressure control, heart function improvement and blood sugar control are normal.Communicate fully with the doctor, explain your concerns, and be prepared.
Postoperative care
It is normal to have a small amount of bleeding 48 hours after the operation. If there is a large amount of bleeding or bleeding, you should go to the hospital in time for corresponding treatment;
In case of pain, use pain killers appropriately according to the doctor's advice;
Regularly go to the hospital for dressing change, and determine the dressing change interval according to the amount of wound secretion and inflammation;
Change the dressing every day or every other day, and then the interval will be slightly longer until recovery.
Surgical excision or elevation of small skin tissue of affected nail
It is suitable for chronic paronychia patients with recurrent paronychia.
TCM treatment
Ichthyol ointment、JinhuangsanSuch traditional Chinese medicine can be used locally at an early stage, with disinfection and convergence effects.
Other treatments
Ultrashort wave and infrared ray treatment: It is suitable for local application and drug treatment when there is no suppuration at the initial stage of paronychia.
prognosis
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Paronychia may recur and cause pain;The foot can affect normal walking, bring great inconvenience to patients' life, work and study, and even cause psychological pressure.If the focus is not removed in time, the recurrence rate can reach 60%~80%.
Different types of paronychia have different prognosis:
The prognosis of acute paronychia is good.
The prognosis of chronic paronychia is closely related to the compliance of patients.There are occupational risks, and patients who use nail cosmetics or suffer from ingrown nails or nail dysplasia are more likely to relapse.Repeated inflammatory stimulation can lead to hyperplasia of periungual granulation tissue.
complication
The probability of complications of paronychia is low, and those with severe condition may have suppurative finger (toe) cephalitisosteomyelitisEtc.
prevention
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Chronic paronychiaAvoid contact with water, irritantsAllergenAnd avoid trauma.Wear cotton gloves when contacting water, and then put rubber or plastic gloves on the outside to keep hands dry. Do not push the nail fold and do not use nail polish.
