Inflammation of the proximal nail fold.

Consequence of biting or chewing the periungual tissue of the nail.

May result from an aggressive manicure.

Acute inflammation results from invasion and proliferation of bacteria under the fold.

Characterized by inflammation of the posterior or lateral finger nail fold and presents with perungual pain, erythema and swelling.

Usually gram positive organisms, especially Staphylococcus aureus, are involved and may lead to abscess formation.

Often caused by traumatic inoculation of the fold with skin flora, usually as noted above with staphylococci.

Oral flora may be present in cases of nail biting or thumb sucking.

May be a chronic process in individuals exposed to frequent water exposure to the hands.

Chronic process seen in food handlers, housewives, and person exposed to high humidity, detergents and other irritants.

Chronic irritation and maceration of the proximal nail fold lead to inflammation and swelling of the nail fold and impaired formation of the cuticle.

The cuticle protects the nail matrix from the environment by sealing the skin to the nail plate and its disruption causes penetration of microorganisms under the nail fold.

When microorganisms accumulate under the nail fold the nail matrix is damaged and the nail plates develops an irregular surface which becomes discolored with dirt and infection.

Treatment is dependent on the severity of the process.

Mild cases without abscess formation can be treated conservatively, with warm compresses or soaks.

Topical antistaphylococcal antibiotics with or without topical corticosteroids can frequently be utilized, and the combination may be superior to topical antibiotics alone.

In the presence of abscess formation, incision and drainage is performed along with the previous treatments.

Oral antibiotics can be administered in refractory cases and in cases with comorbidities such as diabetes, peripheral vascular disease, or an immunosuppressed state.

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