Symptoms of Paronychia
Paronychia on the fingers often occurs due to injuries such as pricks, tearing of hangnails, or cutting nails too short; paronychia on the toes is usually caused by ingrown toenails or tight shoes. It mostly happens on the big toe and is more commonly seen in teenagers or women.
At the beginning of paronychia, the subcutaneous tissue on one side of the nail experiences redness, swelling, and pain. Some cases may resolve on their own, while others can quickly develop into abscesses. The pus spreads from one side of the nail groove to the skin under the nail root and the opposite nail groove, forming a semi-circular abscess. Paronychia generally does not present with systemic symptoms. If left untreated without incision and drainage, the abscess can spread under the nail, leading to a subungual abscess. Yellowish-white pus can be seen under the nail, causing separation between that part of the nail and the nail bed. A subungual abscess can also be caused by direct puncture wounds to the nail or infection of traumatic hematomas under the nail. If not handled promptly, it can lead to chronic paronychia or chronic osteomyelitis of the phalanges. In cases of chronic paronychia, there is a small pus sinus opening beside the nail groove with granulation tissue protruding outward. Chronic paronychia can sometimes lead to secondary fungal infections.
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