Paronychia, or an ingrown nail, is caused by the introduction of bacteria into the nail fold, which can cause cellulitis and/or abscess formation. Typically, a single nail is involved, although multiple nails may be affected in rare, chemotherapy-induced cases. Generally, nail grooming behaviors, abnormal or scarred nail matrix architecture, nail biting, and wet work are the causes of acute or chronic disease.1
Conservative options are a reasonable first choice when there is no abscess. These include soaks 2 to 3 times daily for 15 to 20 minutes in hot water or water treated with an antiseptic, such as chlorhexidine. Topical or oral antibiotics aimed at suspected organisms may be helpful. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, is a common isolate. Psuedomonas is characteristic in cases involving trauma to the hand and frequent workplace water exposure, as can happen in foodservice, farming, and marine industries.
When an abscess has formed (as in this case), or when conservative treatments fail, incision and drainage or partial nail avulsion can be curative and successful with, or without, antibiotics. Patients with recurrent paronychia in the same location may benefit from partial nail avulsion with partial matrix removal. This can be done surgically or with phenol.
In this case, the patient underwent lateral partial nail avulsion, which also served as an incision and drainage. She was not given antibiotics and her nail regrew within 6 months; there was no recurrence. She was counseled not to cut the nail plate too aggressively.
Text and photos courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. (Photo copyright retained.)