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Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes mellitus than in non-diabetic peers.

OBJECTIVE: Paronychia occurs frequently in adolescents, but there are no data about its prevalence in adolescents with type 1 diabetes mellitus (DM1). We investigated the presence and characteristics of nail-bed infections in a group of adolescent patients with DM1 aged 10-20 years. METHODS: Ninety-three children and adolescents with DM1 and 100 healthy age-matched controls were studied using a structured questionnaire. Frequency, duration and treatment of paronychia and, in the DM1 group, duration of DM, mean HbA1c, frequency of hypoglycemia, footwear and foot care were evaluated. All patients with DM1 underwent a complete neurological examination including vibration perception, thermal perception, and light touch perception. RESULTS: Adolescents with DM1, particularly girls, had a higher frequency of paronychia than controls (34.4% vs 23%; p < 0.01). Diabetic patients with paronychia were older than those without and had a longer duration of DM1, while there was no difference in long-term HbA1c between the groups. Vibration perception was impaired in all regions measured, compared to healthy adolescents. Subclinical neuropathy and microalbuminuria was found to be more frequent in patients with paronychia than in those without. CONCLUSION: We conclude that foot examination is important and mandatory in adolescents with DM1.

Adolescent↗

Acute and chronic paronychia.

Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet. Any disruption of the seal between the proximal nail fold and the nail plate can cause acute infections of the eponychial space by providing a portal of entry for bacteria. Treatment options for acute paronychias include warm-water soaks, oral antibiotic therapy and surgical drainage. In cases of chronic paronychia, it is important that the patient avoid possible irritants. Treatment options include the use of topical antifungal agents and steroids, and surgical intervention. Patients with chronic paronychias that are unresponsive to therapy should be checked for unusual causes, such as malignancy.

Abscess↗

Paronychia.

Paronychia is defined most often in terms of inflammation and is classified as congenital, acute-acquired, or chronic-acquired. The cause for acquired paronychia usually is trauma, and middle-aged women are at greatest risk. Chronic paronychia has been associated with numerous occupations where fluids are the common denominator. Mixed infections usually are found in chronic paronychia, including bacteria, fungus, and yeast. Depending upon the type of paronychia and associated organisms, therapy includes footgear considerations, pharmacology measures, and surgical measures.

Acute Disease↗

Role of foods in the pathogenesis of chronic paronychia.

BACKGROUND: Chronic paronychia is a condition that is pathologically characterized by spongiotic inflammation; it can be exacerbated by various and concomitant factors. OBJECTIVE: The aim of this study was to assess whether chronic paronychia in food handlers may have clinical, pathologic, and immunohistochemical similarities with immediate contact dermatitis caused by foods. METHODS: Twenty food handlers affected by chronic paronychia were submitted to patch tests with the fresh foods that were suspected of being the cause of the dermatitis. RESULTS: Nine patients had a positive reaction to a 20-minute open patch test with fresh foods applied on the proximal nailfold. In two patients the pathologic study of the positive open patch test site showed acanthosis, exocytosis, and spongiosis of the epidermis and the presence of an inflammatory lymphocytic infiltrate in the dermis. CONCLUSION: Our results confirm the view that an immediate hypersensitivity reaction to foods can be responsible for some cases of chronic paronychia in food handlers.

Adolescent↗

Eponychial marsupialization and nail removal for surgical treatment of chronic paronychia.

A long-term retrospective study of patients with chronic paronychia treated by eponychial marsupialization with or without nail removal is presented. Twenty-eight consecutive fingers with chronic paronychia in twenty-five patients were surgically treated. Symptoms had been present for 28 +/- 7 weeks. Twenty-three of these had nail irregularities. Of this group, the first seven fingers were treated with marsupialization alone. Recurrences developed in two of these. The next sixteen patients with nail irregularities were treated with marsupialization plus nail removal, and there were no recurrences (p less than 0.05). Furthermore, when the two recurrent paronychia were treated with both procedures, one healed completely and the other was markedly improved. All fingers without nail irregularities healed with marsupialization alone. These results confirm that eponychial marsupialization is an effective means of treating chronic paronychia and suggest that nail removal should be done when concurrent nail irregularities are seen.

Adult↗

Chronic paronychia in which hair was a foreign body.

A patient who worked as a baker and a part-time barber had chronic paronychia. Biopsy revealed the presence of hair in the dermis of the nail fold. This is only the second case of chronic paronychia to be reported in which the dermis contained nonmicrobial exogenous material. Based on experimental work it has been previously suggested that the rounding out of the posterior nail fold in most paronychia is due to the body's reaction to the penetration of debris derived from Candida albicans. However, patients recalcitrant to therapy or those exposed to chemicals or particulate material deserve detailed histologic study.

Adult↗

Indinavir-related recurrent paronychia and ingrown toenails.

Lamivudine and indinavir are two medications used to treat human immunodeficiency virus (HIV) that have recently been reported to cause paronychia. The nails of the great toes are commonly affected. This is the second report of paronychia and ingrown toenails due to indinavir and the first report of recurrent paronychia and ingrown toenails associated with this drug.

Adult↗

[Paronychia, the general practitioner, the surgeon and antibiotics (author's transl)].

Antibiotic therapy for paronychia has seen its day. It is indicated only rarely and justified only when on the day following infection or during the next few days there are signs of regional or systemic spread. The surgical treatment of infections of the hand is not difficult but should be known, if not learned. A paronychia which has been opened but not cured should be reoperated upon rapidly. An "old" paronychia is a major catastrophe: small fistula, great damage. No surgical quarter for evil organisms!

Anti-Bacterial Agents↗

Anaerobic paronychia.

During 1 year 116 patients with paronychia had bacteriological cultures of the pus. Aerobic bacteria, predominantly Staphylococcus aureus were isolated from 81. Anaerobic bacteria were isolated from 35, and in 31 of these aerobes were also present. Anaerobic paronychias were less acute that those caused by aerobes but otherwise the clinical features and management were the same. The anaerobes isolated were those found as oro-pharyngeal commensals and did not include the colonic commensal Bacteroides fragilis. They were, with few exceptions, sensitive to penicillin.

Adolescent↗

Severe paronychia due to zidovudine-induced neutropenia in a neonate.

We describe the case of an HIV-perinatally exposed child who was treated with zidovudine prophylaxis for reduction of perinatal transmission. At 4 weeks of age, he developed severe paronychia of the great toes as a result of Candida albicans and Escherichia coli. At that time, laboratory tests showed anemia and neutropenia. Zidovudine-related hematologic toxicity resolved after completion of the prophylactic regimen and the infant became HIV-antibody negative (seroreverter) at 8 months of age. Paronychia resolved after treatment with oral fluconazole and topical antiseptics but the soft tissue of the nailfold was penetrated by the edge of the nail plate, resulting in the formation of a cutaneous bridge over the nail that resolved by spontaneous necrosis. To our knowledge, this rare complication has not previously been described in an HIV-perinatally exposed child treated with zidovudine.

Anti-HIV Agents↗

Aerobic and anaerobic microbiology of paronychia.

Pus specimens from 28 patients with paronychia of the finger yielded bacterial growth by techniques for cultivation of aerobic and anaerobic bacteria. Anaerobic and aerobic organisms only were isolated in pure culture in five (18%) and eight patients (29%), respectively; mixed aerobic and anaerobic flora were present in 15 patients (54%). Seventy-two isolates were recovered, or 2.6 isolates per specimen. The predominant anaerobic organisms were Gram-positive anaerobic cocci, Bacteroides species, and Fusobacterium species. The predominant aerobic organisms were Staphylococcus aureus, gamma-hemolytic streptococci, Eikenella corrodens, group A beta-hemolytic streptococci, alpha-hemolytic streptococci, and Klebsiella pneumoniae. Candida albicans was recovered in four cases. This study demonstrates the mixed aerobic and anaerobic bacteriology of paronychia.

Adult↗

Occupational protein contact dermatitis and paronychia from natural rubber latex.

Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. The correct diagnosis would not have been established if prick testing with NRL had not been performed. This case shows that contact allergy presenting as dermatitis may occur despite negative patch test results. PCD from NRL may be relatively common, although very few cases have been published. This is probably due to the fact that the term contact urticaria is so closely connected to NRL that automatically all cases of type I allergy to NRL are considered contact urticaria, although the clinical picture is a dermatitis, i.e. PCD.

Adult↗

Paronychia in association with indinavir treatment.

To assess a possible association between antiretroviral treatment and paronychia, we conducted a retrospective cohort study of 288 human immunodeficiency virus-positive protease inhibitor recipients. Indinavir treatment-adjusted for age, sex, CD4 count, diabetes status and other antiretroviral drug exposures-was significantly associated with paronychia of the great toe (hazard ratio 4.7; 95% confidence interval 1.6-13.9).

Adult↗

Paronychia--a manifestation of pemphigus vulgaris.

Involvement of the nail unit in pemphigus vulgaris is thought to be uncommon. However, trachyonychia, nail atrophy, onychomadesis, onycholysis, nail bed erosion, onychoschizia, subungual haemorrhage, nail pitting, nail plate discoloration, cross-ridging of nail plate, Beau's line and paronychia have been reported. These manifestations may be due either to secondary extension of the bulla adjacent to the nail or primary involvement of the nail bed, nail matrix and nail fold. We report four patients with pemphigus vulgaris who developed paronychia with a corresponding exacerbation of their cutaneous lesions. Nail fold biopsy and direct immunofluorescence revealed features of permphigus vulgaris. Treatment with immunosuppressive agents showed simultaneous improvement of both cutaneous and nail lesions.

Adult↗

Epidemiology of chronic paronychia in a skin hospital in Singapore.

A retrospective epidemiologic study of 110 patients with chronic paronychia (CP) showed a female-male ratio of 2.3:1, whereas the ratio of patients attending the same clinic was 1.1:1 (p less than 0.001). The peak age range of patients with CP (40-49 years) generally was greater than that of the general dermatologic patients (20-29 years). Seventy-seven percent of the patients with CP were "manual workers," of which 48% were homemakers. Chronic paronychia was more common on the right fingers than the left fingers. The most commonly affected fingers were the right thumb (62%), followed by the right middle finger (52%), left thumb (57.6%), and left middle finger (51.5%). Mechanical trauma appears to be an important predisposing factor in CP. Sixty-two percent of 68 patients who had nail fold smears had positive findings for budding yeast cells, suggestive of candidal infection. All of the six patients for whom nail fold bacterial cultures were performed had positive results for enteric flora.

Adult↗

Fractures of the terminal phalanx presenting as a paronychia.

Three fractures at the base of the terminal phalanx of the finger and one at the base of the terminal phalanx of the tow were initially misdiagnosed as paronychias. If a 'paronychia' follows trauma, the possibility of a fracture should be considered and radiographs taken of the digit.

Adolescent↗

Paronychia.

Trauma to the nail folds can allow pathologic bacteria to invade this region. Once a primary, active infection has occurred in a nail fold, the area is often predisposed to chronic paronychia. Both chronic and acute paronychia are discussed, including their causes and treatments.

Acetates↗

Chronic paronychia and onycholysis: a thirteen-year experience.

We report here on two retrospective studies conducted between 1982 and 1995 in 137 patients with clinical evidence of chronic paronychia or onycholysis. The purpose of the studies was to determine what factors played a role in these nail disorders. The culture results indicated that yeast commonly grew from the cultured material. Significant contact irritant exposure was frequently found. These findings and our experience suggest that the resolution of chronic paronychia and onycholysis depends on avoiding exposure to contact irritants and on appropriate treatment of any underlying fungal infection. To accomplish this latter goal, it is important to select a broad-spectrum antifungal agent that is effective against yeasts as well as other fungal pathogens.

Adolescent↗