The paronychia, called popularly felon or whitlow, is an inflammation of the skin around the nail, usually of bacterial origin, which comes after injuries in this region. Paronychia can be acute, lasting a few days, or chronic, lasting for several weeks.
The paronychia is, in most cases, a bacterial infection, which causes severe inflammation in the skin of the corner of the nail. The paronychia may arise in the fingers or toes.
Inflammation occurs when common skin bacteria can contaminate wounds produced around the nail, usually after minor trauma such as lesions in the cuticle, nail biting, cutting the excess nail, stubbing his toe, use of tight shoes, or when the manicure "takes a steak" of your finger. It is important to understand that the skin is a physical barrier that protects our body against the outer environment germs. Whenever this barrier suffers an injury, it appears a gateway so that the skin bacteria have access to deeper tissues.
In addition to trauma, other situations may also cause small cracks in the skin around the nail, favoring the invasion by bacteria. Among the risk factors we can mention, thumb sucking, jobs that require hands are immersed in water for too long, frequent hand contact with chemicals, people who work with gardening, patients with diabetes mellitus or patients with circulatory problems in members.
In most cases, the injury is invaded by bacteria that colonize our skin. The most common agent is the bacterium Staphylococcus aureus. Other bacteria can also cause skin paronychia, including the Streptococcus and Pseudomonas.
When the lesion of the skin around the nail is caused by bites or by the act of biting the nail, natural microorganisms of the mouth can be the invader agent, including, in addition to Staphylococcus and Streptococcus bacteria as corrodens Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas.
If in acute paronychias bacteria are the most common causes in the chronic form the infectious agent may be the fungus Candida albicans. However, even in the chronic forms, the prevalence of bacterial infection is also high, being common mixed infection by bacteria and fungi simultaneously.
The chronic paronychia may also be caused by an eczematous process with inflammation of the skin unrelated infectious agents. In these cases there is no infection, inflammation only. This form is common in people who work with chemicals or living with wet hands.
Acute paronychia usually affects a single finger and is characterized by inflammation, with swelling, redness and pain in one of the corners of the nail, in the region where there was the trauma that led to bacterial invasion. It is common for the infection gives rise to a small abscess is often possible to notice the presence of pus under the skin. The patient has the right corner of the inflamed nail with a small white or yellow spot, which is the collection of pus just beneath the epidermis.
In the acute form, the inflammation comes on quickly, just a few hours after the skin is injured. The framework has evolved quickly, and the inflammation reaches its peak in about 1 or 2 days. Fever does not usually occur. If this is a sign that infection may be spreading. One of the common complications of paronychia is erysipelas or cellulitis.
The chronic form usually has a less intense inflammation and is not usual be put. The tip of the affected fingers usually be fine swollen, but the pain and redness are not as severe. A fingernail can more is ignited at the same time. In the case of fungal infection, the frame has slower installation, taking days to fully emerge inflammation.
In most cases, paronychia can be treated with hot compresses only 3 to 4 times per day, and appropriate local hygiene.
If there are signs of pus, it is recommended to drain it. If the amount of pus is small, a gentle massage finger immersed in warm water tends to facilitate drainage. Remember to keep the area always well clean to prevent reinfection. If swelling and collection of pus are large, the ideal is that the drainage is done by a doctor. Do not try to squeeze abscesses at home.
In most cases it is not necessary to use antibiotics, but if the lesion is progressively getting worse, they can be given to prevent the spread of bacteria to the deeper tissues. The most commonly used antibiotics are cephalexin, amoxicillin + clavulanate or clindamycin.
In cases of chronic paronychia, the most suitable measures are to prevent moisture and contact with chemicals in the affected fingers. To accelerate the cure, ointments antifungals (ketoconazole, itraconazole or fluconazole) and corticoids can be used. In some cases, when there is no associated infection, a simple ointment corticosteroids is sufficient.
