Thursday, June 18

Paronychia causes - Paronychia pictures

  ›     ›     ›   Paronychia causes - Paronychia pictures

What causes paronychia?

Paronychia is an inflammation of the proximal and/or lateral nail folds of a toe or finger.
Paronychia is usually caused by bacterial or fungal infection. It usually develops when there is damage to the bond between the nail plate and the adjacent nail fold.

Paronychia is a tender, painful condition. Depending upon the causative factors and the length of morbidity period, the nail fold infection is termed as acute, chronic, candidal or pyogenic paronychia. Damage to the junction between nail plate and nail fold or to soft nail fold tissue surrounding the nail is the primary cause. Certain occupational exposures, cancers, certain systemic diseases and suppression of the immune response may also make a person susceptible nail fold infection.

Damage to eponychium, paronychium and hyponychium

The eponychium is the proximal nail fold that produces the cuticle cover on the proximal end of nail. Together with the cuticle, eponychium form a protective seal on the proximal end of nail plate.
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Damage to eponychium may occur from dropping of heavy objects on toes or fingers, manicure procedures or biting or picking at cuticle. Damage to eponychium can lead to infections and cause pyogenic paronychia.

Paronychium or perionychium is the lateral nail fold. Paronychium is the soft tissue surrounding the lateral border of the fingernail or toenail. It protects from anything getting underneath the nail. Damage to paronychium may occur when any heavy object falls on the finger or toe and from biting or picking at hangnail, dishwashing, ingrown nail or any sharp object cutting or piercing it. Such damage can cause infection and acute paronychia.

The hyponychium is the tissue found beneath the nail plate at the junction between the free edge and the skin of the fingertip. It protects the nail bed. Damage to hyponychium may occur from dishwashing, injury from a splinter or thorn or nail biting. Any injury to hyponychium can cause infection.(see image below)

Paronychia caused by certain habits

Onychophagia or nail biting, is an oral compulsive habit. Nail biting causes deleterious effects in fingers such as broken skin on the cuticle, hangnails and damage to nail bed. The fingers become susceptible to microbial infections such as paronychia.(see image below)
image of acute paronychia compared to normal finger
image of acute paronychia compared to normal finger
(Picture author: DRosenbach | CC BY-SA 3.0)
picture of acute paronychia
picture of acute paronychia
Thumb sucking starts as an instinctive nutritional sucking behavior and continued in some children as physical and emotional fulfillment. Thumb sucking generally stops by the age of 5 years. However, continuous wetting of the nail fold with saliva can cause chronic fungal infection. (see picture below)
picture of chronic paronychia
picture of chronic paronychia
(Picture author: Rob Hille | CC BY-SA 3.0)
A hangnail or agnail is a small, torn piece of eponychium or paronychium. Dry skin, cold weather, harsh chemicals, frequent immersion in water or nail biting can cause hangnails. Though hangnail by itself is harmless, biting or picking hangnail can cause infection and paronychia. (see image below)
picture of paronychia by picking at a hangnail
picture of paronychia caused by picking at a hangnail

Ingrown nail

Ingrown nail, especially toenail, is caused by the nail piercing and entering inside the paronychium. The condition leads to a microbial inflammation of the paronychium and nail fold infection. (see image below)
picture of paronychia - ingrown toenail
picture of paronychia caused by ingrown toenail

Occupational exposures

Frequent bare hand contact with chemicals, detergents and medications can disrupt the bond between the nail fold and nail plate leading infection and inflammation.

Dishwashing is an important triggering factor for . The decaying food particles and dirt can get lodged between the nail plate and the skin fold. The cuticle may separate from the nail plate, leaving a gap between the proximal nail fold and the nail plate. This leads to paronychium inflammation and infection.

Dentists are frequently exposed to viral infections from oral fluids of patients and prone to develop viral nail fold infection or herpes whitlows.

Pathologists and laboratory workers handling tuberculotic cadaver and also veterinarians and butchers handling tuberculosis affected animals can develop prosector's paronychia when their nail and nail folds get inoculated by tubercle bacilli.

Other causes of paronychia

The carcinomas of the upper aerodigestive tract manifest as acrokeratosis paraneoplastica with symptoms like erythematous, keratotic rash and nail fold inflammation.
Pemphigus, a blistering autoimmune diseases can show symptoms like nail fold inflammation.
Nail fold infection is more common in adult women, diabetics and people with weak immune systems.
Paronychia is also common in immunocompromised patients and those under drug-induced immunosuppression.
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References:
1.Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.
2.Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar;22(3):165-74.
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Saturday, June 13

What is Paronychia? - Nail fold infection

  ›     ›     ›   What is Paronychia - Paronychia definition

What is paronychia?

Paronychia (nail fold infection) is an inflammation of the proximal and/or lateral folds of tissue surrounding the nail of a toe or finger.
Paronychia can also be defined as nail fold inflammation caused by bacterial or fungal infection. Nail fold infection typically develops following a breakdown in the bond between the nail plate and the adjacent nail fold and subsequent infection of the skin fold.
Paronychia web definition
The merriam-webster.com defines as: "inflammation of the tissues adjacent to the nail of a finger or toe usually accompanied by infection and pus formation."
The American Heritage Dictionary definition: "Inflammation of the tissue surrounding a fingernail or toenail."
The English Wiktionary defines nail fold infection as: "An infection under the cuticle of a fingernail or toenail."
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The collinsdictionary.com definition: "a bacterial or fungal infection where the nail and skin meet on toes or fingers."

Types of paronychia

Depending upon the suddenness of onset, extent of time taken to resolve and the causative agents, the nail fold infection is termed as acute, chronic, candidal or pyogenic paronychia.

Acute paronychia

A disease lasting less than six weeks is considered acute. The nail fold infection starts usually in the paronychium fold at the side of the nail with symptoms such as local swelling, redness, tenderness and pain. It resolves within six weeks.

A disease lasting more than six weeks is considered chronic. It is a persistent and relapsing condition mostly caused by fungus. The chronic type of nail fold infection occurs in individuals whose hands or feet are subject to moist local environments.

Candidal paronychia

This a nail fold disease caused by fungus, quite often by Candida albicans. Candidal paronychia tends to be chronic and recurrent.

Pyogenic paronychia

The bacterial infection of the nail fold is known as pyogenic paronychia. The skin typically becomes red and hot. Usually an abscess filled with pus is formed. The progression is fast and the condition is very painful. The condition may resolve soon after antibiotic treatment.
Image of paronychia
Paronychia of finger

Nail fold infection

Several factors are known to cause this inflammation and disease. Some are the causes are listed below:
  • Foreign matter getting lodged between nail plate and lateral skin,
  • The binding between the ungual plate and the surrounding skin tissue getting disturbed,
  • biting or picking at a hangnail,
  • finger sucking,
  • frequent contact with chemicals,
  • nail biting,
  • ingrown nail,
  • damage to soft tissue during manicure procedures and
  • physical damage or injury to the soft tissue surrounding the nail.
Certain occupational exposures, certain types of malignancy, immunosuppression and certain systemic diseases may predispose a person to develop paronychia.

Nail fold infection symptoms

The symptoms associated with this condition are apparent. The symptoms include reddening, inflammation, tenderness, pain, formation abscess and discharge of pus from the affected area.

Nail fold infection

Depending upon the condition of the affected nail, several treatment options can be considered. Some of the treatment options are:
  • applying warm compresses,
  • applying emollient lotions,
  • applying topical antibiotics,
  • applying corticosteroids,
  • taking oral antibiotics,
  • surgical incision to drain pus and
  • in severe or recurrent cases of paronychia removing the affected nail is recommended.
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References on paronychia:
1.Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.
2.Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar;22(3):165-74.
3.Duhard É. Paronychia. Presse Med. 2014 Nov;43(11):1216-22.
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Current topic in natural skin care: What is Paronychia and its definition.
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Wednesday, June 10

Ingrown toenail symptoms

  ›     ›     ›   Symptoms of ingrown toenails
An ingrown toenail, or onychocryptosis, is a common painful condition that most often affects the outer edge of the big toe.
However, ingrown toenail can occur on any toe and also on both sides of the toe. The initial symptoms of ingrown toenail are mild pain, reddened skin and swelling at the corner of the toenail.

The symptoms of onychocryptosis develop as a reaction to a foreign body, when the toenail pierces and enters the flesh (the ungual labia folds) surrounding it. Considering the progress of symptoms, Jonathan D. Mozena (Podiatr Med Assoc. 2002 Mar;92(3):131-5) had classified onychocryptosis into stages I, IIa, IIb and III. Martínez-Nova A et al. added a new stage IV.

Symptoms in early stage of ingrown toenail

Early stage is an inflammatory stage with the following symptoms:

Abscess stage of ingrown toenail

  • There is increase in erythema, swelling and pain. Hyperesthesia (increased sensitivity) is experienced by the patient.
  • The patient may experience continuous throbbing, stabbing pain.
  • There is hypertrophy of toenail fold. It extends over the ungual plate, but measures less than 3 mm.
  • Clear, thin, watery serous drainage may begin.
  • Next, it may progress into serosanguineous exudate, which is thin, watery, and pale red to pink in color. The pink tinge is due red blood cells leaking from damaged capillaries.
  • In this stage, infection may set in, causing seropurulent exudate of thin, watery, cloudy, and yellow to tan in color.
image of wounded infected toenail
Infected ingrown toenail

Advanced abscess stage of ingrown toenail

  • There is further increase in erythema, swelling, excruciating pain and hyperesthesia.
  • The hypertrophy of toenail fold extends over the ungual plate and measures more than 3 mm.
  • Paronychia, an infection of the paronychium (soft tissue surrounding the border of the toenail), caused by Staphylococcus, Pseudomonas, Candida or superficial dermatophytes occurs.
  • Thick, opaque, purulent, foul smelling exudate of tan, yellow, green, or brown in color may discharge from the infected wound.
  • The affected area may feel hot to touch.

Symptoms in hypertrophic stage of ingrown toenail

  • In hypertrophic stage, the earlier symptoms like erythema, swelling, excruciating pain, hyperesthesia and pus discharge continue.
  • The hypertrophy becomes chronic with the increase in the volume of lateral fold tissue due to the enlargement of its component cells.
  • The hypertrophic fold tissue widely covers the lateral ungual plate.
  • Granulation tissue composed of new connective tissue and tiny blood vessels forms on the surfaces of the wound.

Symptoms in distal hypertrophic stage of ingrown toenail

  • The hypertrophic tissue completely covers the lateral, medial and distal ungual plate.
  • The toenail and the lateral and distal skin folds undergo chronic deformity.
  • If untreated cellulitis and osteomyelitis can occur.
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References on symptoms of ingrown toenails:
1.Heidelbaugh JJ, Lee H. Management of the ingrown toenail. Am Fam Physician. 2009 Feb 15;79(4):303-8.
2.Reyzelman AM, Trombello KA, Vayser DJ, Armstrong DG, Harkless LB. Are antibiotics necessary in the treatment of locally infected ingrown toenails? Arch Fam Med. 2000;9(9):930–932.
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Current topic in natural skin care: Ingrown toenails symptoms.
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