From the Guidelines
Paronychia, an infection of the skin around the nail, is the most relevant condition related to the perionychium, and its management should prioritize prevention and proper nail care, as well as addressing underlying causes and using targeted treatments as needed. The perionychium includes the cuticle (eponychium), lateral nail folds, and hyponychium (tissue beneath the free edge of the nail) [ 1 ]. Disorders affecting this area, such as paronychia, can be acute or chronic, with acute paronychia typically resulting from bacterial infection (often Staphylococcus aureus) following trauma, and chronic paronychia often caused by repeated irritation or fungal infection [ 1 ].
Prevention and Management
Preventive measures for paronychia include:
- Gentle skin care instructions
- Preventive correction of nail curvature
- Avoidance of repeated friction and trauma/excessive pressure
- Wearing gloves while cleaning
- Avoiding biting nails or cutting nails too short
- The use of antimicrobial soaks and washing with cleansers and water
- Regular trimming of the nails ensuring that they are straight and not too short
- Daily application of topical emollients to cuticles and periungual tissues
- Wearing comfortable well-fitting shoes and cotton socks [ 1 ]. Therapeutic management of paronychia should start with conservative measures such as high-potency topical corticosteroids alone or combined with topical antibiotics, and may include oral antibiotics or surgical treatment for more severe cases. Topical povidone iodine 2% b.i.d. has shown benefit in a controlled study for grade 1 and 2 paronychia [ 1 ].
Key Considerations
- Understanding the anatomy of the perionychium helps explain why infections in this area can be painful and sometimes difficult to treat due to the confined space and rich blood supply.
- Proper nail care and maintaining dry hands can prevent paronychia and other conditions affecting the perionychium.
- Addressing underlying causes, such as repeated irritation or fungal infection, is crucial in the management of chronic paronychia [ 1 ].
From the Research
Definition and Causes of Paronychia
- Paronychia is an inflammation of the folds of tissue surrounding the nail, specifically the proximal and/or lateral nail folds 2.
- Acute paronychia is mainly caused by bacterial infection, such as Staphylococcus aureus or Streptococcus, and sometimes viral infection (herpetic whitlow) 2.
- Chronic paronychia is often the result of numerous conditions, including the disappearance of the cuticle, contact dermatitis, and bacterial or mycological infections 2.
Symptoms and Treatment
- Paronychia presents as an acute or chronic condition, with symptoms including localized, superficial infection or abscess of the paronychial tissues of the hands or feet 3.
- Treatment options for acute paronychia include warm-water soaks, oral antibiotic therapy, and surgical drainage 3.
- For chronic paronychia, treatment options include topical antifungal agents, steroids, and surgical intervention, as well as avoiding possible irritants 3.
Prevention and Management
- General preventive measures can be useful in maintaining health and preventing paronychia, especially as an occupational disease 4.
- A new combination of topical medications, including an insulating polymer, antifungals, and an anti-inflammatory molecule, has been shown to be effective in treating and preventing moderate and chronic paronychia 4.
- This treatment has been found to be safe and effective, with a clinical cure rate of 46.6% and improvement in 40% of patients 4.