Chronic Paronychia

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Chronic paronychia represents an inflammatory reaction of the proximal nail fold to irritants or allergens. It affects hands that are continually exposed to a wet environment and to multiple microtrauma, favouring cuticle damage. Secondary colonization with Candida albicans and/or bacteria occurs in most cases.

Patients with chronic paronychia should avoid a wet environment, chronic microtrauma and contact with irritants or allergens. Application of high-potency topical steroids (clobetasol propionate 0.05%) once a day at bedtime is an effective first-line therapy. If Candida is present a topical imidazole derivative should be applied in the morning. Topical antifungal agents alone and systemic antifungal therapy are not useful. In severe cases, intralesional or even systemic steroids (prednisone 20 mg/day) can be used for a few days to obtain a prompt reduction of inflammation and pain. Acute exacerbations of chronic paronychia do not necessitate antibiotic treatment since they subside spontaneously in a short time. Pseudomonas colonization can be treated with sodium hypochlorite solution or 2% acetic acid. Complete recovery of the condition usually requires several weeks and treatment should be continued until the cuticle has regrown. Recurrences are frequent since the barrier function of the proximal nail fold may be impaired for months or even years after an episode of chronic paronychia. In rare cases, foreign bodies such as hair or fibreglass spicules can be responsible for chronic paronychia. These patients should be treated by the excision of a crescent-shaped, full-thickness piece of the proximal nail fold, including its swollen portion. Complete healing by granulation takes about 4 weeks.

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