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Paronychia is an inflammation of the skin around the nail, often due to bacteria or fungi. Its sudden (acute) occurrence is usually due to the bacterium Staphylococcus aureus . Gradual (chronic) occurrences are typically caused by fungi, commonly Candida albicans .
A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. eponychium; H. free margin. Onychia is an inflammation of the nail folds (surrounding tissue of the nail plate) of the nail with formation of pus and shedding of the nail. Onychia results from the introduction of microscopic pathogens through small wounds.
Onychomadesis is defined by the nail plate's detachment from the matrix, its continuous connection to the nail bed, and, frequently but not always, shedding. [4] Beau lines are transverse ridges on the nail plates. [5]
For home treatment, the American Academy of Dermatology recommends clipping the loose piece of skin with a clean nail clipper or nail scissors, and applying over-the-counter antibiotic ointment if the area appears inflamed. Persistent hangnails should be evaluated by a physician. [5]
As of 2020, there have not been controlled, blinded studies on the treatment of green nail syndrome [16] and there are no treatment guidelines as of 2021. [8] Keeping the nails dry and avoiding excessive immersion of the nails are key. [11] In some cases, surgical removal of the infected nail may be required, [16] as a last choice. [8]
[19] [20] Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting skin lesion(s), including the location (such as arms, head, legs), symptoms (pruritus, pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology (macules, papules ...
When kept dry and away from further trauma, the nail will reattach from the base upward (i.e., from proximal to distal). The aim of treatment is also to eliminate onychomycosis that is a major cause of onycholysis. Antifungals like terbinafin and itraconazole in the form of oral pills should be given for 6 to 8 weeks. [11]
Here are links to possibly useful sources of information about Paronychia. PubMed provides review articles from the past five years (limit to free review articles) The TRIP database provides clinical publications about evidence-based medicine. Other potential sources include: Centre for Reviews and Dissemination and CDC