Paronychia is a dermatological disease with inflammation of the periarticular roller caused by trauma, exposure to chemicals or high temperature, followed by infection. Symptoms of this condition are redness, swelling and soreness in the area of the roller, possibly with the development of suppuration and abscess. With long-term chronic inflammatory processes, it is possible to change the shape and structure of the nail. Diagnosis of paronychia usually does not cause difficulties and is made on the basis of the results of an examination by a specialist, in some cases additional research methods are used to clarify the cause of the pathology. Treatment of paronychia is carried out by traditional anti-inflammatory, antibacterial and other means, depending on the etiology of the disease.
Paronychia or inflammation of the periarticular roller (periarticular panaritium) is an inflammatory lesion (usually acute, chronic forms are less common) of the skin tissues surrounding the nail growth zone. This is a very common disease, almost every person has suffered some form of such inflammation at least once in their life. In persons who, due to their professional duties, come into contact with industrial or household chemicals and some other means, paronychia can be considered as an occupational pathology. Often, inflammation acquires a purulent character with the formation of an abscess of the nail roller, while the loss of the nail or the transition of the infectious process to deeply located tissues with the development of tendinitis and even purulent melting of the phalanx may occur. Timely treatment of paronychia is of great importance to prevent complications of this inflammatory disease.
Modern dermatologists refer paronychia to polyethological diseases with many forms and varieties of clinical course. The most common form of this condition is caused by the penetration of infectious agents into the tissues of the periarticular roller: Staphylococcus aureus, streptococcus, fungi and a number of others. Predisposing factors for infection and subsequent development of paronychia are injuries, frequent mechanical effects, high temperatures and contact with certain chemicals. After the infectious agent enters the tissues, it begins to multiply, triggering immune counteraction mechanisms that manifest themselves as simple or purulent inflammation.
This is how the inflammatory process develops in almost 90% of cases of acute paronychia. At the same time, the focus of inflammation of the periarticular roller is mostly located on the side of the palm surface of the finger, but due to the peculiarities of the anatomical structure of this anatomical structure and complex lymphocirculation in this area, the main manifestations are localized on the back side. The lesion of the underlying tissues can cause a wide spread of the infectious process to the deeply located tissues of the finger and even the hand.
The development of inflammation or abscess can cause not only infection – similar manifestations sometimes accompany other dermatological diseases. In particular, paronychia is isolated due to eczema, psoriasis and some forms of syphilis. As a rule, in these cases, the inflammation is not acute, but chronic, it is accompanied by pronounced changes in the structure and shape of the nail. The causes of the development of paronychia in eczema or psoriasis have not been thoroughly studied, as, in fact, the etiology of these conditions in general. Another form of inflammation of the nail roller without infection are professional types of paronychia that occur when working in factories, contact with household chemicals and other substances. Inflammatory manifestations in such cases are caused by the direct damaging effect of certain compounds on the tissues of the periarticular roller.
Classification and symptoms
There are many clinical forms of paronychia. The reason for their differences lies in the polyetiology of the disease, which affects the course of pathology. In addition, differences largely determine the tactics of treatment of paronychia, the principles of therapy can vary significantly depending on the etiology of inflammation of the nail roller. The modern clinical classification of paronychia used in dermatology includes the following types of pathology:
- Simple paronychia – can act as an independent disease or be the first manifestation of other forms of this condition. The cause of this type of inflammation is infection, exposure to temperature or physical factors. Simple paronychia is characterized by redness, swelling and moderate soreness in the area of the nail roller. As a rule, in the absence of progression, the severity of symptoms gradually decreases, recovery occurs after 5-10 days.
- Pyococcal or purulent paronychia is a form of the disease caused by infection of tissues with purulent microflora, most often with staphylococci and streptococci. It occurs quite often. Symptoms of this condition are sharp swelling and pain (often of a pulsating nature). After 2-3 days of redness, an abscess of the nail roller begins to form, due to the accumulation of pus, the roller acquires a yellowish tint. Subsequently, the abscess spontaneously breaks through or is opened by the surgeon, the manifestations of pyococcal paronychia weaken and gradually disappear. In the absence of treatment, purulent inflammation may spread to other tissues of the finger and hand. In rare cases, metastatic transfer of the pathogen with the development of abscesses in internal organs is observed.
- Candidamycotic paronychia (confectioners’ disease) is a type of this pathology caused by infection of tissues with fungi of the genus candida. It almost always develops in the presence of a combination of predisposing factors: frequent contact with the pathogen, mechanical irritation of the nail phalanges, a reduced level of immunity. It is characterized by moderate inflammation, sometimes there is a slight suppuration. The course of the disease is long. A typical manifestation of candidamycotic paronychia is the disappearance of the eponychium, a thin layer of skin above the nail roller. Over time, the fungus can also affect the nail itself, this is manifested by thickening, delamination, changing the color and shape of the nail plate.
- Ulcerative paronychia – a feature of this type of disease is the development of ulceration on the nail roller. As an etiological factor, both pathogenic bacteria and various chemical effects (contact with caustic compounds, components of household chemicals) can act. Ulcers are quite painful and often become the entrance gate for secondary infection, which leads to the development of purulent paronychia.
- Horny paronychia is a rare type of disease characterized by the development of hyperkeratosis of papular elements on the surface of the nail roller. Most often it indicates a syphilitic lesion of tissues.
- Paronychia in eczema or psoriasis – occurs quite rarely, has its own characteristic features. With the development of eczema, the nail roller is moderately inflamed, vesicular elements may appear on its surface, crusts form after their destruction, peeling of the skin is observed. Paronychia caused by psoriasis covers the entire nail phalanx of the finger, accompanied by peeling. The nail roller is inflamed, serous or serous-purulent fluid is sometimes released from under its surface.
It is quite easy to determine the presence of inflammation of the nail roller when examining the patient’s fingers. Swelling and redness are almost always detected, and soreness is detected on palpation. The pyococcal form of the disease is characterized by a sharply swollen roller, which can acquire a yellow hue due to the accumulation of pus. Additional diagnostic methods help to more accurately determine the form of paronychia. To make a diagnosis, anamnesis is collected, microbiological studies are prescribed, in some cases a general dermatological examination is used (to detect eczema or psoriasis) and serological tests (to determine syphilis).
When questioning and clarifying the anamnesis of a patient with paronychia, it is possible to detect professional forms of this disease – the pathology often affects bakers, employees of laundries and workers of chemical enterprises. Detection of concomitant pathologies (eczema, psoriasis, syphilis) in the patient’s anamnesis indicates their role in the development of paronychia, especially with a characteristic clinical picture of the corresponding disease. In the presence of purulent or serous secretions, microbiological examination (microscopy, sowing on selective nutrient media) is performed for more accurate identification of the pathogen.
The treatment of paronychia is largely determined by the causes that provoked this disease. In case of pathology caused by infection of the nail roller, local antiseptics and ichthyol ointment are used. With the purulent nature of inflammation and the development of an abscess, surgical autopsy and drainage are performed, antibiotic therapy is prescribed. With signs of candidamycotic paronychia, local forms of antifungal drugs (for example, clotrimazole) are used. If the inflammation of the nail roller is caused by exposure to some chemical compound, the patient is recommended to limit contact with an aggressive substance or wear protective gloves. In paronychia due to eczema, psoriasis or syphilis, in addition to the general therapy of the underlying disease, corticosteroid ointments and ultraviolet irradiation of the affected areas are used.
In the vast majority of cases, the prognosis of paronychia is favorable – with properly conducted therapeutic measures, the disease is completely cured and does not threaten the life and health of the patient. In chronic forms caused by occupational factors or other pathologies, aesthetic problems are possible due to changes in shape and structure or even loss of nails. To prevent this condition, it is necessary to adhere to the rules of personal hygiene, use antiseptics for finger skin injuries, use gloves and other protective equipment when working with aggressive compounds.