Folliculitis Furuncles Hidradenitis Suppurativa Carbuncles Paronychial Infections Erythrasma Paronychial Infections Acute or chronic infection of the periungual tissues. It is caused by infections of mixed bacteria and fungi, usually C. albicans . Eventually, the chronically infected nail becomes distorted. Acute paronychia may begin as a hangnail or ingrown nail and develop into an abscess in the paronychial fold adjacent to the nail plate. It causes rapid onset of pain, swelling, and erythema around a fingernail or toenail.
Chronic paronychia is relatively insidious in onset.
In chronic recurrent inflammation, subungual debris should be cultured for bacteria and for C. albicans or C. parapsilosis. Infection extending along the tendon sheaths requires prompt surgical incision, drainage, and referral to a hand surgeon. In chronic recurrent infections, the nail should be cut back to its point of detachment from the underlying skin. Unresponsive cases may need treatment with the oral triazole antifungals, itraconazole or fluconazole. Because the GI tract is a likely source of C. albicans, oral nystatin 500,000 U qid may also be advisable.