Acquired nail dis part

4. Paronychia is one of the most
common infections of the hand.
Paronychias are localized,
superficial infections or abscesses
of the perionychium.
Paronychial infections
develop when a disruption occurs
between the proximal nail fold and
the nail plate that allows the entry
for invading organisms
.

5. Less than six weeks duration longer than six weeks duration

6. Usually results from a minor(e.g. nail biting)
trauma that breaks down the physical
barrier between the nail bed and the nail
allowing the infiltration of infectious
organisms, S. aureus is the most common
infecting organism.
 contact irritants
 excessive moisture.
 Occupations such as baker,
bartender and dishwasher.
 nail biting or sucking

7. Acute paronychia The presenting
complaints are:
o pain
o tenderness
o swelling in one of the lateral Nail
folds.
The affected area often:
• erythematous
• swollen
• In more advanced cases,pus may
collect under the skin of the lateral
fold
CLINICALLY

8. If untreated,
the infection can extend into
the eponychium and in severe
cases, the infection may track
proximally under the skin of
The finger to produce a
(whitlow) abscess

9. The treatment of choice depends on the extent of the infection.
acute paronychia without obvious abscess can be treated
• non- surgically, often with topical antibiotics alone.
If an abscess has developed
• incision and drainage must be performed.
• Oral antibiotics with Gram-positive cover- age against S.
aureus, such as cephalexin, amoxicillin with clavulanic acid,
and clindamycin, are effective.
TREATMENT

10. is an inflammatory disorder that almost exclusively
involves the fingernails of adult women.
CHRONIC PARONYCHIA

11. in persons whose hands are repeatedly exposed to moist
environments or
in those who have prolonged and repeated contact with
irritants such as mild acids, mild alkalis, or other chemicals.
People who are most susceptible include housekeepers,
dishwashers, and swimmers.(commonly predominant hand)
Predisposing factors

12. Repeated Mechanical or chemical traumas damage the cuticle
permit penetration of irritant and allergenic environmental
substances under the proximal nail fold
causing an inflammatory
Secondary colonization with Candida sp. and/or bacteria
occurs in most cases.

13.  the proximal and lateral nail folds show mild erythema
swelling, and the cuticle is absent.
 The nail plate may show superficial abnormalities
 green discoloration due to Pseudomonas invasion.
CLINICALLY

14. Hand protection from the environmental hazards is mandatory
for remission of chronic paronychia ,which can be considered
cured only when the cuticle has regrowth.
Systemic antifungals are not effective.
topical steroids associated with topical antiseptics to prevent
secondary microbial colonization
TREATMENT

16. Bacteria are not capable of attacking a healthy nail plate.
The Gram-negative bacterium Pseudomonas aeruginosa may
colonize under favorable conditions, such as chronic
paronychia or onycholysis.
The presence of Pseudomonas is revealed by characteristic
green–black nail pigmentation due to pyocyanin staining.
GREEN NAILS

17. • Topical application of a few drops of diluted bleach or
chlorhexidine solution two or three times a day clears the
pigmentation in a few weeks.
• Administration of systemic antibiotics is unnecessary
TREATMENT

18. o the most common periungual growth is in the periungual wart,
o warts are most common in children who bite their nails, warts
on the lateral nail fold & on the finger tip may extend deeply
under the nail.
o warts are epidermal growths, but if massive they can erode
underlying bony matrix by displacement.
WARTS

19. TREATMENT