From the Guidelines
Paronychia presents with characteristic physical exam findings around the nail fold, including erythema, swelling, and tenderness of the lateral or proximal nail fold, as well as potential pus collection or fluctuance indicating abscess formation, as described in the 2021 Annals of Oncology study 1. The affected area typically shows signs of inflammation, such as redness and swelling, which can be graded according to the CTCAE v5.0 severity scale, as outlined in the study 1. Some key physical exam findings of paronychia include:
- Erythema (redness) of the nail fold
- Swelling of the nail fold
- Tenderness to palpation
- Potential pus collection or fluctuance
- Shiny and tense skin around the nail due to inflammation
- Discoloration or distortion of the nail plate in advanced cases
- Expressible pus with gentle pressure on the nail fold
- Loss of the cuticle and separation of the nail fold from the nail plate (eponychial detachment) in chronic cases
- Nail ridges, thickening, or discoloration over time in chronic cases It is essential to distinguish between acute and chronic paronychia, as their management differs, with acute cases often requiring drainage if an abscess is present, while chronic cases need long-term management of predisposing factors, as discussed in the study 1.
From the Research
Physical Exam Findings of Paronychia
The physical exam findings of paronychia are not explicitly described in the provided studies. However, the studies do mention the clinical presentation of paronychia, which can be used to infer the physical exam findings.
- The studies describe paronychia as an inflammation of the fingers or toes in one or more of the three nail folds 2, 3, 4, 5.
- Acute paronychia is characterized by the presence of an abscess, which can be determined through physical examination 2, 3, 4.
- Chronic paronychia is characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier 2, 3.
- The physical exam findings may include redness, swelling, and tenderness of the affected nail fold, as well as the presence of pus or discharge 5, 6.
- In some cases, paronychia may be associated with onychomycosis, which can cause changes in the appearance of the nail 5.
Classification of Paronychia
Paronychia can be classified as either acute or chronic, with different physical exam findings and treatment options for each type.
- Acute paronychia is typically characterized by the sudden onset of symptoms, including redness, swelling, and pain 2, 3, 4.
- Chronic paronychia is characterized by persistent symptoms, including redness, swelling, and tenderness, as well as changes in the appearance of the nail 2, 3, 4.
Special Considerations
In certain cases, such as in neonates, the physical exam findings of paronychia may be different from those in adults 6.
- Neonates with paronychia may present with symptoms such as redness, swelling, and pus or discharge, as well as systemic symptoms such as fever 6.