Paronychia- is a term that is used to describe an infection of a nail plate at the junction where the nail and skin meet. This may be along the base of the nail or along the sides of the nail as a result of onychocryptosis. If the paronychia begins suddenly, we refer to it as “acute.” If it more of a gradual process, we refer to it as “chronic.”
The cause of the infection may be caused by bacteria or candida (yeast). Typically, a paronychia caused by bacteria will ooze a yellow or light red discharge where as a candidal infection will exude a white chalky discharge. Furthermore, fungal infections can also cause paronychias.
Along the base of the nail plate is the cuticle and if it is disrupted in any way, bacteria can work its way under the proximal nail fold and cause an infection (paronychia). Typically, the base of the toe just behind the nail plate will become red, swollen and painful. If there is a large amount of pus or yellow drainage from the nail fold, one must seek medical attention to have the toe drained.
Paronychia’s that involve the inner, outer and proximal nail folds (the skin around the entire nail plate) is referred to as a run-around paronychia.
If mistreated long enough, a local infection can manifest to more serious systemic problems such as red streaks, swollen lymph nodes, fever and sepsis. In addition, the local soft tissue infection can lead to bone infections or osteomyelitis if left untreated for a long time. Thus, it is imperative that prompt treatment of paronychias is of utmost importance. Antibiotics and foot soaks are not adequate treatment for paronychias. Proper treatment involves removing a portion of the toenail or the entire toenail that is penetrating into the nail fold(s).
In severe cases, where both borders are infected and there is severe curvature (cryptosis) of the nail plate, a total nail plate removal is advised. Most of the time however, only the side(s) of the nail plate are required to be removed. The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas, will also give you a prescription for oral antibiotics.
If the paronychia has been present for several months or even years, a radiograph or x-ray may be taken to rule out any underlying bone infection or other causes of the pain around the nail such as a bone tumor or a foreign body.
Accutane, which is a medication to treat acne has been linked to the development of paronychias. Those that frequently wash their feet regularly can cause the skin to become dry and cracked which jeopardize the seal of the cuticle. Other sources of paronychias can be industry related such as trades that involve food processing and those that work in the medical and dental fields. Certain skin cancers such as squamous cell carcinomas can resemble paronychias. It also should be noted that there is a high recurrence rate with paronychias if they are not treated permanently, with a chemical or surgical matrixectomy. More information about matrixectomies can be found under the chemical and surgical matrixectomy section of this website.
Dr. Eric Silvers is a highly-trained foot and ankle surgeons specializing in the treatment and resolution of toenail pathologies.
We have two locations: McKinney, TX & Prosper, TX.
Please call 972-542-2155 to schedule an appointment today!