Paronychia Research Articles

Trauma a major contributing factor of retronychia: Case series

IntroductionRetronychia is defined as a condition where the proximal nail plate grows into the proximal nail fold with the formation of multiple layers of nail plates. It relates to frequent microtrauma that affects the toenails, especially the big toe and it is less common on the fingernails. Case presentationCase 1: A 14-year-old female presented with nail growth stopped and painful swelling in her left hallux that did not respond to antibiotics. The patient had been traumatized at the same toenail. Retronychia was diagnosed, and nail avulsion was performed. Case 2: An 18-year-old man came with painful swelling and stopped growth in his right great toenail that did not improve with antibiotics. The patient had previously trauma the same toenail. Retronychia was diagnosed clinically, and nail avulsion was performed. Case 3: A 30-years-old woman presented with Inflammation and pain in her right toenail. She mentioned a previous trauma to her foot. Retronychia was diagnosed clinically and she underwent onychectomy. DiscussionRetronychia is a chronic nail abnormity based on unresolved chronic proximal paronychia caused by disintegrated nail growth and several generations of nail plate localization underneath the damaged nail. The most common reason for retronychia is trauma which also happens after repetitive micro-trauma. Clinical diagnosis is the basis of retronychia. Retronychia treatment varies between surgical treatment and conservative treatment. ConclusionThis paper highlights the importance of considering retronychia as a potential differential diagnosis in cases of chronic paronychia, and stresses the significance of early detection to prevent complications.

Nail changes in patients receiving systemic isotretinoin therapy

In this study, it was aimed to describe isotretinoin-induced nail changes and increase patients’ treatment compliance. A total of 200 patients diagnosed with acne vulgaris were included in the study. 100 of the patients were started systemic isotretinoin treatment and 100 control patients were receiving topical acne treatment. Age and gender of all of the participants, duration of treatment, total doses per month, and type of nail changes were recorded. Patients with persistent nail changes were followed at the 3rd and 6th months after treatment. A total of 34 patients had nail changes in the isotretinoin group. These changes included onychoschizia (55.9%), leukonychia (11.8%), onychorexis (8.8%), median nail dystrophy (5.9%), pyogenic granulomas (5.9%), chronic paronychia and granulation tissue (5.9%), onycholysis (2.9%) and Beau’s line (2.9%). The rate of nail changes in the isotretinoin group was significantly higher than in the topical treatment group (34% vs. 11%, p:0.001). Isotretinoin increases the risk of nail changes, primarily onychoschizia. The risk of developing nail changes is not associated with treatment duration but is associated with the total cumulative dose. Nail findings induced by isotretinoin are completely reversible.

Newborn Filiform Periungual Hyperkeratosis: A Prospective Observational Study.

Newborn filiform periungual hyperkeratosis (NFPH) incidence and prevalence during the neonatal period remain unknown and have not been described in current literature. Timely diagnosis and treatment are essential to avoid complications during the neonatal period, such as acute paronychia. The aim of our prospective observational study was to describe the characteristics of NFPH in neonates born in a referral hospital in Buenos Aires. One hundred patients were included. Most of them were male (60%). NFPH consists of hard, filiform elements, mostly present bilaterally in lateral nail folds. It was found in 46% of included patients. Prevalence was higher in the right hand. Due to a trend towards easy detachment and fracture, erosions were seen in several cases. Two cases of acute paronychia secondary to NFPH were diagnosed, with favorable outcomes after topical antibiotic treatment. The importance of clinical examination for screening of this local predisposing factor for infection in neonatal patients is highlighted.

Clinical cases of paronychia infection: A narrative review

Paronychia is an infection that occurs in the nail fold and the barrier between the nail and cuticle, is usually caused by penetrating trauma, which allows pathogens to infect and cause damage. The infection is caused by chemical factors, such as fungi, viruses, and bacteria, and risk factors, such as occupation, allergies, and finger-biting habits. Paronychia is a common nail infection that can significantly impact quality of life and work productivity, especially in certain occupations. Paronychia infection was differentiated by two categories, acute and chronic infection. The lack of knowledge regarding the prevention, cure, and rehabilitation of paronychia infection in Indonesia is the cause of the increasing cases of this infection. This review aims to provide knowledge for the Indonesian public and an opportunity for health workers to explore paronychia cases in Indonesia. The data in this paper were retrieved from 32 articles from 2014–2024 from PubMed, Cochrane, and Scopus. Articles were selected based on relevance to clinical cases of paronychia in humans, focusing on diagnosis, treatment and outcomes. Then, evaluate the causes, diagnosis, and treatment of paronychia using narrative review. Found that acute paronychia results from trauma or infection, while chronic cases are often caused by fungi. Treatment in acute paronychia is done with warm soaks and oral antibiotics, while chronic requires long-term topical corticosteroids and antifungal treatments. This review analyzes clinical cases of acute and chronic paronychia to evaluate their causes, diagnosis, and treatment. Further research is needed to advance the knowledge and treatment of paronychia infections.

Nail Disorders in Patients Living with HIV Coinfected with Monkeypox: A Clinical Study in 69 Mexican Cases

Introduction: Several infectious diseases can present nail manifestations, which may be useful for diagnosis and prognosis, and only a few reports have been made regarding monkeypox (mpox). The objective of this study was to describe the clinical characteristics of nail alterations in patients living with HIV coinfected with mpox. Methods: A prospective, cross-sectional study included patients living with HIV/AIDS, coinfected with mpox. We examined all 20 nails in search of nail plate alterations. Patients were divided into two groups, with and without nail disease, and the CD4 count was noted according to the Centers for Disease Control and Prevention (CDC) classification. A χ2 or Fisher’s exact test for qualitative variables and Mann-Whitney U and Kruskal-Wallis tests with post hoc Bonferroni test for quantitative variables were used to compare them. Data were analyzed with the SPSS Statistics 25 software. Results: Sixty-nine patients were included. The frequency of nail involvement was 58%. Papulonodular lesions were the most frequent type identified, with 21 cases (30.4%). A significant difference was observed between patients with nail disease versus median CD4 count (160 vs. 700/mm3; p = 0.002) and median HIV viral load (45,000 vs. 900/mL; p = 0.009). When comparing the characteristics of the nail lesions with the CDC Classification System for HIV infection by the CD4 count, a significant difference was observed in foot involvement, splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy (p < 0.05). Conclusions: The frequency of nail lesions is high in patients living with HIV coinfected with mpox. In addition, they tend to be more destructive in patients with lower CD4 counts and higher viral loads.

Tackling Inflammatory and Infectious Nail Disorders in Children.

Nail disorders are common in the pediatric population and affect quality of life. We review inflammatory conditions (ie, nail psoriasis, nail lichen planus [NLP], trachyonychia, nail lichen striatus, nail atopic dermatitis [AD]) as well as infectious conditions (ie, nail disease due to hand, foot, and mouth disease [HFMD] or Kawasaki disease, onychomycosis, acute paronychia). Inflammatory and infectious nail conditions may involve the skin or occur in isolation. By highlighting the distinctive features and clinical presentations of these infectious and inflammatory nail disorders in children, we aim to raise awareness among dermatologists to improve diagnosis and management.

Severe Onychomycosis with Dermatophytoma Successfully Treated with Long Pulsed Nd: Yag Laser

Onychomycosis is a highly prevalent disease, with an incidence of 10% in general population. Rates are even higher in the elderly, reaching 50% in individuals over 70 years. In addition to the obvious aesthetic impairment, functional debility also occurs as patients often experience pain, difficulty putting on shoes and walking, fungal spread to the skin and risk of acute paronychia. Furthermore, it is a gateway for bacteria and can lead to erysipela [1].

Chronic ulcerative paronychia: a possible further clinical manifestation of mucocutaneous lupus erythematosus in four dogs

In this study, the signalment, clinical signs, histopathological findings and treatment outcome of four dogs with chronic ulcerative paronychia, that presented clinical and microscopic characteristics of the mucocutaneous variant of canine chronic cutaneous lupus erythematosus are described. The Greyhounds in the case series had a symmetric claw fold involvement, either exclusively or as major clinical presentation.

Differential Diagnosis of Retronychia, Onychomycosis and Onychomadesis.

In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts. We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient's complaint was solved after around one year without any specific therapy. The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments. The differential diagnosis of retronychia, onychomycosis and onychomadesis is challenging.Both onychomadesis and retronychia share a common pathophysiologic mechanism.A careful and detailed history prevents a patient from a frightening diagnosis and painful, long-lasting treatment of nail disorders.

Injury-Induced Acute Paronychia in Healthcare Professionals: A Single-Centre Study

Injury-Induced Acute Paronychia in Healthcare Professionals: A Single-Centre Study

Frequency of patients presenting with Hand Infection and treatment modalities

Introduction: Infections of the hand are one of the most common infections reported by the caring physicians and surgeons. Common types of hand infections include: bite wounds, felon, necrotizing fasciitis, paronychia, flexor tenosynovitis, subcutaneous/cellulitis, osteomyelitis and septic arthritis. Aims: The aim of this study to identify the main etiological factors, possible complications due to acute hand infection and treatment modalities performed in our selected group of patients. Materials and Method: This was a prospective Cross Sectional Observational Study based on 58 patients conducted at King Abdullah Hospital, Bisha, Saudi Arabia. Period of study was one year from May 2022 to April 2023. Patients of all age group were included. Male patients were 16 (27.5%) while females were 42 (72.4%). Result: Most of the patients were gardener / farmer 15 (25.9%), minor children 12 (20.7%), and housewife / maid 9 (15.5%). Major mechanism of injury was penetrating trauma 41 (70.7%). Majority of the patients were between 20 years to 50 years of age group. The risk factors associated with hand infection includes diabetes mellitus 13 (22.4%) and hypertension 5 (8.6%). The smokers were 13 (22.4%) patients. Most of the patients were Saudi national 30 (51.7%) followed by Egyptian12 (20.7%), Pakistani and Sudanese 4 (6.9% each). Surgical intervention includes, incision and drainage in 40 (68.9%) cases while amputation was performed in 3 (5.2%) cases. There were 15 (25.9%) patients treated with conservative treatment protocol. Major organisms causing infection was staphylococcus aureus 28 (48.30%) including methicillin resistant staphylococcus aureus (MRSA). There was no growth in 5 (8.6%) patients and for 19 (32.8%) patients no drainage collection was available and therefore their samples were not analyzed for bacteriology. We have categorized the diagnosis into 6 groups as subcutaneous infection 27 (41.5%), acute Paronychia 11 (16.9%), web space infection 10 (15.4%), pulp space infection7 (10.8%), flexor tenosynovitis 6 (9.2%) and midpalmer/thenar 4 (6.2%). Conclusion: Early clinical diagnosis based on occupational history and control of co-morbid disease such as diabetes mellites, smoking etc is effective in the treatment and prevention of hand infection to avoid devastating surgical intervention of partial or total diabetic hand amputation.

Retronychia in children: A case series.

Retronychia is characterized by proximal ingrowing of the nail plate into the proximal nail fold. It is always associated with the presence of two or more overlapping nail plates under the proximal nail fold, clinical signs of chronic proximal paronychia refractory to antimicrobial treatment, and a yellowish nail that does not grow. It mainly affects young female adults, with less than 30 pediatric cases described in the literature so far. Retrospective and observational study of patients between 0 and 18 years with a clinical and/or ultrasound diagnosis of retronychia attending a pediatric dermatology service between December 2020 and January 2022. We identified 9 patients with retronychia, 7 girls and 2 boys. In all cases, the hallux nails were affected with 5 unilateral and 4 bilateral cases. On physical examination we observed the following signs: thickened and opaque nail plate (one patient), yellowish nail plate (7 patients), double nail plate (6 patients), and erythema with edema, pain, and suppuration of the proximal nail fold (7 patients). Ultrasound was performed in 7 patients and specific findings of retronychia were found in 5 of them. All patients received topical treatment and were referred for the appropriate surgical treatment. To date, only one patient underwent nail avulsion, which was followed by complete recovery. Retronychia is underdiagnosed, particularly in the pediatric population. We present a series of 9 cases of retronychia in children, with clinical and ultrasonographic findings consistent with those of adults. We emphasize the importance of recognizing this entity, which will allow early and adequate treatment.

Chemical sealing of proximal nail fold with cyanoacrylate glue for accelerated regeneration of nail cuticle as a treatment of chronic paronychia

Chemical sealing of proximal nail fold with cyanoacrylate glue for accelerated regeneration of nail cuticle as a treatment of chronic paronychia

Chronic mucocutaneous candidiasis and immune dysregulation due to STAT1 Gain of Function

BackgroundGermline gain-of-function (GOF) mutations in the Signal Transducer and Activator of Transcription 1 (STAT1) gene have been associated with autosomal dominant chronic mucocutaneous candidiasis (CMCC), autoimmune and inflammatory manifestations. Although most patients with STAT1 GOF have CMCC, the disease has a broad phenotypic spectrum.Case Description: A 13-year-old male born to non-consanguineous parents with a past medical history of chronic mucocutaneous candidiasis, autoimmune hypothyroidism, and recurrent viral respiratory tract infections presented for immune evaluation. His medical history was also significant for chronic fatigue refractory to thyroid replacement therapy, chronic paronychia, oral thrush, pneumonia requiring hospitalization, recurrent chalazia status post excision, and prolonged tonsillitis. Laboratory results showed high total serum IgG levels with elevated IgG1 and IgG3 subclasses, elevated B cell counts with atypical lymphocytes, and chronic EBV-viremia. He had no clinical or laboratory evidence of active lymphoproliferative disease. He had normal lymphocyte proliferation to mitogens with impaired response to antigens. He had an adequate humoral response to protein and polysaccharide antigens. Targeted genetic testing for inborn errors of immunity showed a heterozygous variant in the STAT1 gene (c.1169T>C, p.MET390Thr), which had been previously reported in patients with STAT1 GOF. The patient was treated with oral fluconazole with interval improvement in CMCC and subsequently maintained on prophylactic fluconazole and TMP/SMX. He had an unremarkable family history, which suggests a de novo mutation in STAT1. ConclusionThe presence of CMCC and autoimmunity should raise concern for STAT1 GOF. Genetic testing for inborn errors of immunity can be a valuable tool in the diagnosis of patients with CMCC and can help guide therapy. Unfortunately, hematopoietic stem cell transplant has been associated with a high mortality rate in patients with STAT1 GOF. JAK inhibition therapy was recommended for this patient. However, there is currently no consensus regarding JAK inhibitor selection, dosing, treatment duration or biomarkers in STAT1 GOF.

Histopathological analysis of chronic paronychia.

Chronic paronychia is an inflammatory process of the nail folds lasting more than 6 weeks. Clinically, there is hypertrophy and retraction of the folds and absence of the cuticle. Treatment involves clinical measures and, when there is no response or the hypertrophy of the folds is very pronounced, surgical treatment is indicated. Post-surgical histopathology is little studied in the literature. In this sense, we believe that the histopathological study is important not only for the individualized understanding of the patient's chronic disease, avoiding relapses, but also for the understanding of its pathophysiology and treatment possibilities. To describe the histopathological changes found in biopsies of the proximal nail fold of patients with chronic paronychia undergoing surgical treatment. A histopathological study of 16 nail folds from 6 patients after surgery was performed at 2 study centers. The most prevalent epidermal findings were orthokeratosis, hypergranulosis, acanthosis and spongiosis and the dermal findings were fibrosis and mononuclear inflammatory infiltrate. The histopathological study allowed us to conclude that chronic paronychia is primarily an inflammatory process, but it is not possible to conclude whether microorganisms such as Candida and bacterial cocci are part of the etiology or just secondary and opportunistic agents.

Case Study

ABSTRACT This is a case study of a 55-year-old woman presenting with dystrophic nails that arose during her teenage years and has worsened over the last few years. The patient reported frequent wet work, exposure to irritants, and cuticle manipulation. The physical examination showed proximal nail fold bolstering, loss of cuticle, and a wavy dorsal nail plate resembling a “washboard.” She was diagnosed with chronic paronychia and onychotillomania. She was prescribed clobetasol ointment and sulfacetamide in ethanol and was counseled on hygiene and at-home care. One month after the regimen was started, there was noticeable reduction of inflammation to the cuticle.

Role of Homoeopathy in Managing Chronic Paronychia: A Pretest–Posttest Interventional Study

Abstract Background Chronic paronychia (CP), one of the commonest recalcitrant nail disorders, is a troublesome source of considerable discomfort to the patients, which negatively affects the quality of life (QoL) mainly of the housewives reporting in the Indian subcontinent. Objective The aim of this study is to assess the utility of individualised homoeopathic treatment (IHT) in managing painful episodes with the improvement in QoL of CP patients. Method A pretest–posttest clinical study was conducted on 40 patients with CP. The Numeric Rating Scale (NRS) and Dermatology Life Quality Index (DLQI) were the outcome measures, assessed at baseline and after 2 months of IHT. Modified Naranjo Criteria (MNC) evaluated the possible causal attribution of IHT. Results There was a statistically significant reduction in pain NRS score (8.89 ± 0.84 vs 2.97 ± 1.17; 95% confidence interval [CI] = 5.44–6.39; p &lt; 0.01) as well as DLQI score (19.35 ± 2.95 vs 3.59 ± 1.99; 95% CI = 15.06–16.45; p &lt; 0.01) among 37 patients. The large effect size derived (4.17) clinically, substantiates the beneficial effects in managing the painful episodes of CP. The MNC scores (7–10) ascertained the likelihood of improvement due to IHT. Conclusion IHT significantly reduced the pains due to CP and improved the QoL. Further studies are warranted with enhanced methodology.

Green nail syndrome on the nail plate and bed related with Enterococcus and Fusarium coinfection.

Abstract.

Acute and Chronic Paronychia Revisited: A Narrative Review.

Paronychia refers to the inflammation of the tissue which immediately surrounds the nail and it can be acute (<6 weeks duration) or chronic (>6 weeks duration). Disruption of the protective barrier between the nail plate and the adjacent nail fold preceded by infectious or noninfectious etiologies results in the development of paronychia. A combination of general protective measures, and medical and/or surgical interventions are required for management. This review explores the pathogenesis, clinical features, differential diagnosis, medical, and surgical management of paronychia. For the purpose of this review, we searched the PubMed, Cochrane, and Scopus databases using the following keywords, titles, and medical subject headings (MeSH): acute paronychia, chronic paronychia, and paronychial surgeries. Relevant review articles, original articles, and case reports/series published till February 2020 were included in this study.

Chronic Paronychia of Great Toe Treated with Excision of Nail Plate along with Surrounding Tissue and Split Thickness Skin Graft: An Observational Prospective Study

AbstractParonychia is an inflammatory condition of alongside of nail of toe or finger. It is seen commonly in housewives and housemaids. Paronychia may be acute or chronic. Majority of patients with acute paronychia respond well to nonsurgical treatment. Patients with chronic paronychia of great toe do not respond to nonsurgical treatment. Patients suffer from chronic pain in finger or toe. Many treatment methods are available for chronic paronychia of great toe. All have merits, demerits, and different outcomes. This study is conducted to find out the outcome of a modified surgical technique in chronic paronychia of great toe of patients. This is a method adopted with a little modification of existing method.This study was conducted among 50 patients of chronic paronychia of great toe, who were between 15 to 55 years of age, from December 2019 to December 2020. These patients were operated and kept on follow-up for 1 year and observed for different outcomes likes skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease. Clinical data was recorded in case record form by examining the patient, asking questions to them, and conducting descriptive analysis. Results in terms of skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease were assessed during follow-up period. Postoperative result showed that 98% of patients had complete wound healing and complete graft take up, acceptance of cosmetic appearance was 94%, recurrence was 2%, and 90% were relieved from chronic pain of disease great toe. It was concluded that this was a better method for treatment of chronic paronychia of great toe.