Acute paronychia presents as a rapid onset of swelling, tenderness, and redness of the nail fold. A pustule or abscess may develop and pus can often be expressed from the space between the nail fold and the nail. Erythematous streaks may extend proximally from this area and may be associated with fever. Chronic paronychia has a less abrupt onset, and swelling, tenderness, and redness will wax and wane. Retraction of the cuticle is prominent in chronic paronychia, and the nail plate usually has horizontal ridging [Fig 23.9:1 (Plate. . . . 2.1)].
FIG. 239-1 (Plate...,2.1). Chronic candida paronychia. The cuticle is absent. Erythema and edema are prominent at the proximal and lateral nail folds. The dystrophic ridged nail is a sign of chronic disease.
Other noninfectious causes of paronychia include psoriasis, dermatitis, and even certain medications including Accutane. Because of injury to the proximal nail fold and cuticles, these patients are at risk of developing secondary infection as well. A clue to the diagnosis is sudden exacerbation of the nail disease without exacerbation of other cutaneous disease.
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