Paronychia chronic L03.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

chronic nail crease inflammation; chronic paronychia; Chronic paronychia; Panaritium paraunguale

Definition
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Frequent, chronic, also chronically recurrent, painful, mostly microbial (mainly bacterial) induced inflammation of the paronychium.

Etiopathogenesis
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The causes of chronic paronychia are multifactorial.

  • Mostly irritations caused by lyes, acids, foreign bodies are intiating.
  • Often also caused by aggressive nail care with cutting of the cuticle. S.a.u. Unguis incarnatus).
  • Overlapping by microbial factors such as yeasts (see Paronychia candidamycetica), staphylococci, Pseudomonas aeruginosa (green colouring of the nail).
  • Often also occupational (see below occupational dermatoses)
  • It is more common in peripheral circulatory disorders or as a result of drug therapies - e.g. after the use of retinoids and EGFR inhibitors such as cetuximab.

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Manifestation
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It is mainly women who are affected. Predisposing are wet works. See also the special features of Paronychia candidamycetica.

Therapy
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  • Elimination of the predisposing factors (wetness, aggressive manicure)
  • Targeted protective measures (wearing gloves, avoiding direct contact with aggressive chemicals)
  • In case of chronic recurrent purulent paronychia see acute paronychia below. In this case it is recommended to detect the pathogen.
  • Local therapy with antibiotic ointments (e.g. ointments containing gentamycin)
  • In the case of extensive findings and/or progression of the inflammation under external therapy, antibiotic systemic therapy after an antibioogram. Initial cephalosporins such as cefuroxime (e.g. Elobact) 2 times/day 500 mg p.o. or gyrase inhibitors such as Ofloxacin (e.g. Tavanic 200 mg/day p.o.).
  • Afterwards skin care: Desiccated nail walls should be regularly treated with an O/W emulsion.

General therapy
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Eliminate or change predisposing factors if possible, such as sicca symptoms in atopic eczema, diabetes mellitus, acrocyanosis, hyperhidrosis Discontinue causative medication, e.g. retinoids. If necessary, change professions in baking, nursing, etc.

Literature
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  1. Chanprapaph K et al (2014) Epidermal growth factor receptor inhibitors: a review of cutaneous adverse events and management. Dermatol Res Pract doi: 10.1155/2014/734249
  2. Di Costanzo L et al (2014) Acrodermatitis continua of Hallopeau (ACH): two cases successfully treated with adalimumab. J Dermatologist Treat 25:489-494
  3. Iorizzo M (2015) Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin 33:175-183
  4. Shafritz AB et al (2014) Acute and chronic paronychia of the hand. J Am AcadOrthop Surg 22: 165-174

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020