Paronychia

Paronychia implies chronic inflammation of the posterior nail folds of one or several fingers, and less so, of the toes. The malady affects housewives, servants, waiters and bar attendants whose hands are constantly in water. Injury to the eponychium by careless manicuring can also cause the disease. Clinically, the nail fold becomes red, swollen and boggy. There is separation of the posterior nail fold from the nail plate, leading to the formation of a space full of cheese-like material.

Symptoms of Paronychia

The only symptom is slight irritation or pain. Paronychia is a very chronic condition. The nail is secondarily deformed and atrophied; atrophy starts from the proximal end and slowly extends forwards. To begin with, one finger is affected but soon the other fingers may be involved. Streptococci of low virulence may produce a similar picture. The outlook, in properly treated cases, is good.

Treatment of Paronychia

The author adopts the following regimen (Brain's modification): The space between the posterior fold and nail plate is cauterized with 95 per cent phenol. A small pledget of cotton wool dipped in carbolic acid is pushed under the nail fold with the aid of a dissecting forceps or a sharpened matchstick, and kept there, for one minute.

The excess of phenol is then neutralized with tincture iodi mitis; another pledget of cotton wool soaked in tincture iodine being pushed under the nail fold as before, and kept there for .one minute. This is only done once or twice in the beginning.

The patient is advised to keep his hands out of water, and is told to apply tincture Merthiolate (P) I in 1,000 twice a day or a special lotion containing 3 per cent phenol and 6 per cent tincture iodi fortis in rectified spirit. The nail fold is massaged from above downwards before the paint is applied. In resistant cases, a course of superficial X-ray therapy is very beneficial.

Treatment must be carried on until there is complete recovery and the eponychium is formed. Surgery and antibiotics are not necessary. The patient must avoid too much contact with water and use cotton gloves covered by rubber gloves for doing the essential wet work. The general health of the patient must be improved. Accompanying diabetes, if present, must be treated.