Preparing for Paronychia

Never heard of it?  Neither had I, or at least I didn’t know the actual name for it.  See, paronychia is one of the most common infections of the hand.  It occurs more often in women than men, in about a 3:1 ratio, with middle-aged females being at highest risk.[1]  And while it is already common now, I’m betting we will see a whole lot of it in the challenging times that lie ahead.  With a medical system collapsing right before our eyes, preparing for this and other infections will pay off with huge dividends in the future.

A paronychia is an infection of the nail fold—the area where the skin and the nail meet, usually affecting the fingers but toes are sometimes involved as well.  As people work more with their hands, perhaps without gloves, and perhaps as immune systems weaken, paronychia will become much more common. 

Let’s begin with information from The Ship’s Medicine Chest (the only off-grid medical reference I have that addresses this problem):

Paronychia (Infection of the Nail Fold)

A paronychia is an infection of a nail fold, usually on a finger, marked by redness, pain, and swelling that leads to a discharge of pus.  The acute paronychias of sudden onset usually are caused by bacteria such as staphylococci or streptococci that enter a small cut or scratch around the nail.  The chronic paronychias more commonly are caused by a yeast (Candida) infection that tends to occur in individuals, as dishwashers who immerse their hands in water for long periods of time.

Treatment

Paronychia infections should be treated with warm soaks of aluminum acetate solution (using two packets of 500 ml of water) for 20 minutes three to four times daily.  Incision and drainage is indicated when the lesion points to discharge pus, as with boils. (See p. 235.) An antibiotic ointment such as bacitracin should be applied between soaks.  If fever or swollen painful glands are present in the armpits, systemic antibiotic treatment with erythromycin 250 mg by mouth four times daily for seven to ten days should be given.  Care should be taken to avoid injury to the affected finger and to prevent unnecessary or prolonged contact with water or other liquids.  If the paronychia does not respond to the above measures and becomes chronic, the patient should be referred to a skin clinic for more specific therapy when on shore leave.  Dishwashers and other food service workers should be excused from food preparation until the lesions have healed.[2]

That’s it in a nutshell from The Ship’s Medicine Chest.

More information available online can help us determine whether the infection is bacterial, fungal, or viral and thus treat it more effectively.

Acute Paronychia

Acute paronychia is marked by sudden onset and resolves quickly, within 5-10 days at most.  It is usually a bacterial infection, most commonly with Staphylococcus aureus, though Streptococcus pyogenes and Pseudomonas may also be the culprits.  It may also be due to a herpes simplex or Candida albicans infection.  It can affect anyone and usually affects only a single nail fold.  It most frequently develops after a break in the skin or other injury:

• Nail biting
• Through a hangnail or broken skin
• In infants that suck their fingers or thumbs
• Following a manicure
• Ingrown toenails
• With the application of artificial nails
• Treatment with an oral retinoid that dries the skin[3]

Symptoms

• Throbbing pain
• Redness
• Warmth
• Swelling
• Multiple swelling vesicles (herpes simplex infection)
• Yellow pus may accumulate and develop into an abscess
• Fever (S. pyogenes)
• Lymphangitis (S. pyogenes)
• Lymphadenopathy (S. pyogenes)

Acute paronychia may progress into cellulitis.

Treatment

• Soak the affected digit in warm water or antiseptic solution (chlorhexidine or povidone iodine) for at least 15 minutes 2-4 times per day.[4]
• Apply a topical antiseptic for a localized, minor infection.
• Oral antibiotics may be necessary for a severe, prolonged infection.  Tetracycline or doxycycline are commonly prescribed.  Whatever is used should have coverage for Staphylococcus.[5] Options include:
  
• Cephalexin (500 mg, 3-4 times per day)[6]   
• TMP-SMZ DS (1-2 tablets, twice per day)[7]   
• Doxycycline (100 mg, twice per day)[8]
• Acyclovir may be prescribed for a severe herpes infection.
• Surgical incision and drainage may be necessary if an abscess develops.
• The nail may need to be removed to allow pus to drain (rare).[9]

Chronic paronychia

Chronic paronychia has a more gradual onset and lasts longer than six weeks.  In many cases it develops as a result of dermatitis in the nail fold.  The pathogens most commonly involved are Candida albicans and Pseudomonas.  It mainly occurs in those who have constantly cold and wet hands, such as:

• Dairy farmers
• Fishermen
• Bartenders
• Cleaners
• Housewives
• Dentists
• Nurses
• Those with poor circulation—diabetics, immunosuppressed or compromised patients,[10]

Chronic paronychia develops gradually.  It may begin with only one nail fold but frequently gradually spreads to other fingers.  Each nail fold swells and lifts off the bed, which then permits the entry of other organisms and irritants.  The affected skin may be irritated and red occasionally and sometimes a little pus can be expressed from under the cuticle.  The nail plate also becomes thickened and distorted.  The primary complication with chronic paronychia is nail dystrophy where the nails become distorted and brittle and may turn yellow, green, or black.  It may take up to a year after recovery for the nails to grow back normally.

Treatment

• Keep the hands dry and warm.
• Avoid wet work.
• Keep the fingers extremely clean.
• Wash after dirty work and rinse and dry hands very carefully.
• Apply moisturizing hand cream frequently.
• Oral antifungal (fluconazole) if Candida albicans is suspected.
• Antiseptic or antifungal solutions may need to be applied for months.[11]

Aluminum acetate packets (as advised by The Ship’s Medicine Chest) are available on Amazon.  The most inexpensive are sold under the Domeboro name.  However, chlorhexidine and povidone iodine will be much more readily available and are commonly stocked with the home medical supplies.

Links to related posts:

Dealing with Cellulitis in Doomsday  

Ingrown Toenails—Causes and Treatment  

Erythromycin in Armageddon

Fluconazole for Yeast Infections

The Ship’s Medicine Chest book review 

References:

https://dermnetnz.org/topics/paronychia

https://my.clevelandclinic.org/health/diseases/15327-nail-infection-paronychia

https://www.ncbi.nlm.nih.gov/books/NBK544307/

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[1] https://www.ncbi.nlm.nih.gov/books/NBK544307/

[2] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 242.

[3] https://dermnetnz.org/topics/paronychia

[4] https://www.ncbi.nlm.nih.gov/books/NBK544307/

[5] https://www.ncbi.nlm.nih.gov/books/NBK544307/

[6] https://www.ncbi.nlm.nih.gov/books/NBK544307/

[7] https://www.ncbi.nlm.nih.gov/books/NBK544307/

[8] https://www.ncbi.nlm.nih.gov/books/NBK544307/

[9] https://dermnetnz.org/topics/paronychia

[10] https://dermnetnz.org/topics/paronychia

[11] https://dermnetnz.org/topics/paronychia