Paronychia types carry distinct clinical features, treatment options

October 1, 2010

When patients present with symptoms of redness, pain and swelling around the nail fold on either the fingernails or toenails, the logical diagnosis is paronychia; however, physicians need to know how to identify key distinguishing factors in order to determine precisely which type of paronychia they are dealing with, and effectively treat it.

Key Points

Sewickley, Pa. - When patients present with symptoms of redness, pain and swelling around the nail fold on either the fingernails or toenails, the logical diagnosis is paronychia; however, physicians need to know how to identify key distinguishing factors in order to determine precisely which type of paronychia they are dealing with, and effectively treat it.

The three most common types of paronychia are bacterial, yeast or viral - related to the herpes simplex virus - and each has its own distinctive clinical features.

Paronychia breakdown

A yeast, or Candida, paronychia is differentiated from the bacterial form in that it always involves the proximal nail fold, and patients may present with either an acute or chronic type of yeast paronychia, Dr. Bikowski says.

"Acute forms of Candida paronychia usually involve only one nail unit. The proximal nail fold will be tender, painful, red and swollen and may or may not exude pus from underneath the proximal nail fold," he says.

Chronic Candida paronychia typically involves more than one proximal nail fold.

"The classical presentation will be asymptomatic redness and swelling," Dr. Bikowski says. "Because there is long-term infection/inflammation involving the matrix, the nail plate grows out abnormally."

Chronic Candida paronychia is seen more commonly in people who engage in wet work, such as servers in restaurants, dishwashers or people who frequently have their hands in water.

The third-most common type of paronychia is viral, caused by the herpes simplex virus, and its presentation typically includes grouped, erythematous-based papules, vesicles or pustules in the periungual area.

Also known as herpetic whitlow, the condition can be painful and occurs around the fingernails or on the fingers. While medical professionals are more prone to this type of paronychia due to their frequent direct contact with patients with the herpes simplex virus, safety measures have reduced the risk, Dr. Bikowski says.

"Since the institution of universal precautions and gloves due to HIV concerns, there has been a marked decrease in herpetic whitlows, due to the glove protection," he says.