GPAtlas🧭 When to suspect
Acute paronychia is an acute (< 6 weeks) inflammation, usually infective, of the soft tissue folds bordering a finger or toenail.
It is one of the most common hand infections seen in primary care, develops over hours to a few days, and typically affects a single digit.
The usual organism is Staphylococcus aureus, with Streptococcus pyogenes and occasionally Pseudomonas also implicated. In nail-biters and finger- or thumb-suckers the infection is frequently a mixed aerobic and anaerobic mouth flora.
It follows a breach in the skin barrier – a hangnail, manicure or pedicure, ingrowing toenail, artificial nails, a splinter, or habitual nail biting and picking.
Two clinical priorities drive every consultation:
• Decide whether a drainable abscess has formed (pus needs releasing, not just antibiotics).
• Exclude the dangerous look-alikes and complications – herpetic whitlow (never incise), felon, flexor tenosynovitis, and spreading cellulitis.
| Feature | Acute paronychia | Chronic paronychia |
|---|---|---|
| Onset | Rapid – hours to days | Gradual – persists > 6 weeks |
| Digits | Usually a single nail fold | Often several nails |
| Usual cause | Bacterial (S. aureus) ± mouth flora | Irritant dermatitis ± Candida |
| Clinical picture | • Painful, red, swollen • Pus or abscess common |
Less painful, boggy folds, nail dystrophy |
| Typical trigger | Trauma, nail biting, hangnail | Wet work, dermatitis, occupation |
Lower your threshold and expect a more aggressive course in diabetes, immunosuppression and peripheral arterial disease. Consider drug-induced paronychia (often several nails at once) in patients on epidermal growth factor receptor (EGFR) inhibitors, BRAF inhibitors or oral retinoids.
Source: DermNet
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