Green nail: Etiology and treatment of chloronychia.

"Green nails" or chloronychia results from an infection mostly caused by Pseudomonas sp. but also from other bacterial or fungal contamination. Its presents as a typical triad: green discoloration of the nail plate with proximal chronic paronychia and disto-lateral onycholysis. In a moist environment, Pseudomonas colonizes onycholysis of any origin (traumatic, inflammatory or tumoral). Nail color varies from pale green to dark green, almost black. Treatment consists in cutting of the detached nail plate, brushing the nail bed with a 2% sodium hypochlorite solution twice daily accompanied by moisture eviction by wearing latex gloves over cotton ones for all daily household tasks.

[Hand infections]. / Infections de la main.

HAND INFECTIONS. Hand and finger infections are very common. They result from the inoculation of a germ through the skin barrier. They can range from simple paronychia to extremely serious necrotizing fasciitis. Certain infections, such as those resulting from bites, have their own specific characteristics, which will determine how they are managed. While management can be medical in the early stages, it is important not to ignore the need for surgical treatment, otherwise serious complications may arise, leading to functional and aesthetic sequelae. Delays in treatment cannot be made up. Any infectious lesion can be potentially serious and must be treated in an appropriate department if there is the slightest doubt.

INFECTIONS DE LA MAIN. Les infections de la main et des doigts sont très fréquentes. Elles résultent de l'inoculation d'un germe à travers la barrière cutanée. Elles vont du simple panaris à la gravissime fasciite nécrosante. Certaines infections, comme celles faisant suite aux morsures, ont des caractéristiques propres dont dépend la prise en charge. Si elle peut être médicale au stade initial, il est important de ne pas méconnaître le moment du traitement chirurgical sous peine de voir survenir des complications graves responsables de séquelles fonctionnelles et esthétiques. Le retard à la prise en charge ne peut être rattrapé. Toute lésion infectieuse peut être potentiellement grave et, au moindre doute, doit être prise en charge dans un service adapté.

Retronychia in children: A case series.

BACKGROUND: Retronychia is characterized by proximal ingrowing of the nail plate into the proximal nail fold. It is always associated with the presence of two or more overlapping nail plates under the proximal nail fold, clinical signs of chronic proximal paronychia refractory to antimicrobial treatment, and a yellowish nail that does not grow. It mainly affects young female adults, with less than 30 pediatric cases described in the literature so far. METHODS: Retrospective and observational study of patients between 0 and 18 years with a clinical and/or ultrasound diagnosis of retronychia attending a pediatric dermatology service between December 2020 and January 2022. RESULTS: We identified 9 patients with retronychia, 7 girls and 2 boys. In all cases, the hallux nails were affected with 5 unilateral and 4 bilateral cases. On physical examination we observed the following signs: thickened and opaque nail plate (one patient), yellowish nail plate (7 patients), double nail plate (6 patients), and erythema with edema, pain, and suppuration of the proximal nail fold (7 patients). Ultrasound was performed in 7 patients and specific findings of retronychia were found in 5 of them. All patients received topical treatment and were referred for the appropriate surgical treatment. To date, only one patient underwent nail avulsion, which was followed by complete recovery. CONCLUSIONS: Retronychia is underdiagnosed, particularly in the pediatric population. We present a series of 9 cases of retronychia in children, with clinical and ultrasonographic findings consistent with those of adults. We emphasize the importance of recognizing this entity, which will allow early and adequate treatment.

[Nail disorders in daily practice]. / Nagelafwijkingen in de dagelijkse praktijk.

Familiarity with common nail disorders enables the clinician to diagnose and treat nail disorders and to recognize red-flag conditions. Knowledge of the anatomy of the nail unit is essential to understand the origin of nail disorders. This article focuses on neoplasms, abnormalities of nail color and shape, infections, and inflammatory conditions of the nail unit. There are various neoplasms of and around the nail unit, like squamous cell carcinoma (in situ), melanoma, and benign neoplasms such as mucous cyst, subungual exostosis, glomus tumor, onychopapilloma and fibro(kerato)ma. The most common deviating colors of the nail are red, white and brown-black. Abnormalities of nail color and shape may indicate an underlying systemic disease. Infections of the nail unit include onychomycosis, acute paronychia, pseudomonas nail infection and verruca vulgaris. The inflammatory conditions we discuss in this article are chronic paronychia, psoriasis, alopecia areata and lichen planus.

Red light emitting diode as an adjuvant treatment for epidermal growth factor receptor inhibitors-induced paronychia.

We evaluated the efficacy and safety of red light LED as an adjuvant treatment for epidermal growth factor receptor inhibitor-induced paronychia. Eight patients were recruited in this randomized, single-blinded controlled trial. They were randomized to receive red-light on one hand or foot 2-3 times/week for 6 weeks while the contralateral side served as controls. The standard treatments were continued. Erythema and lesion elevation observed by Anthera® 3D, severity and pain scores were obtained at weeks 0, 2, 4, 6, and 8. The red light group showed significantly lower erythema, severity, and pain scores at weeks 4, 6, and 8. The elevation was significantly lower in the red light group at every follow-up visit. No adverse events occurred. Red light therapy may be an option as adjunctive treatment for EGFRi-induced paronychia.

Treatment of nail diseases in the emergency department.

BACKGROUND: Although Americans seek care for their nail diseases on an outpatient basis, they also seek nail care in the setting of the emergency department (ED). PURPOSE: This study aims to characterize the treatment of nail diseases at ED visits in the United States from 2009-2018. METHODS: Data from 2009-2018 was collected from the National Hospital Ambulatory Medical Care Survey for EDs. RESULTS: There was an estimated 1.54 (95% CI [1.35, 1.74]) million nail visits to the ED from 2009-2018. Whites accounted for the most visits (57%), followed by African Americans (21%). 25-44-year-olds was the age group with the most visits. The South was the region with the most visits (33%). The most common diagnosis was paronychia (42%). Treatments for paronychia included oral antibiotics, incision and drainage, or both. LIMITATIONS: The accuracy of reporting the correct diagnosis remains the biggest limitation. CONCLUSIONS: Nail disease visits accounted for over a million visits to the ED from 2009-2018. All ages and sexes were represented in these visits. Paronychia made up the largest portion of visits and was treated with oral antibiotics, incision and drainage, or both.

Review of chemotherapy-associated paronychia.

Chemotherapy-associated paronychia (CAP) is an inflammation of the nail folds in response to various chemotherapeutic medications. Altered proliferation of keratinocytes or nail matrix stem cells is thought to be a major causative factor. Prophylactic tetracyclines, topical povidone-iodine, and general irritation avoidance measures are among some of the recommended interventions for CAP. Appropriate recognition and treatment of CAP are important for prevention of chemotherapy dose reduction or medication discontinuation.

Bacterial and Viral Infections of the Nail Unit.

Bacterial and viral infections of the nail unit are very common as primary infections, especially bacterial paronychia and warts, but they can also be superinfections complicating other nail disorders. In many nail unit infections, the clinical presentation is nonspecific: in these cases, diagnostic tests are mandatory before treatment, to avoid spread of the infection and drug resistance. The most common forms of bacterial and viral infections that may affect the nail unit are herein described in detail, with diagnostic and treatment options provided.

Fingertip Infections.

The fingertip is the most common site of infections in the hand, which frequently are encountered by surgeons, dermatologists, and emergency and primary providers. Their mismanagement may have serious consequences. This review discusses the unique anatomy of the volar fingertip pulp and perionychium and reviews pathophysiology and treatment of acute and chronic paronychia, including the decision for surgical versus medical management, choice of antibiotics, incisional techniques, and postincisional care. Felons and the evidence regarding their management are reviewed. Several infectious, rheumatologic, and oncologic conditions that may mimic common fingertip infections and about which the managing provider must be aware are presented.

Fungal Infections of the Hand.

Clinically significant fungal infections of the upper extremity are uncommon but increasing They are classified based on anatomic location and epidemiology. The anatomic categories that affect the hand include cutaneous, subcutaneous, and deep. Cutaneous infections are caused by organisms that metabolize keratin and can cause serious morbidity but are rarely fatal. Subcutaneous infections are similar to the cutaneous infections and are produced by low virulence organisms. Cutaneous and subcutaneous infections are most common and can be treated by primary care physicians and dermatologists. Deep infections are less common but can be fatal. Epidemiologic classifications include endemic and opportunistic infections.

Pediatric Hand Infections.

Infections are an important source of morbidity in pediatric hands that come from frequent exposure to mouths and other dangers while exploring the world. Although Staphylococcus aureus is still the most common organism in pediatric hand infections, it is less common than in adults because pediatric patients are more likely to develop mixed aerobic/anaerobic infections or group A Streptococcus pyogenes infection. Pediatric patients with open physes potentially may sustain Seymour fractures of the distal phalanges that may become infected and sources for osteomyelitis if not recognized early.

Retronychia a little-known cause of paronychia: A report of two cases in adolescent patients.

Retronychia is a clinical condition resulting from embedding of the nail plate into the proximal nail fold. We report two adolescent girls, 14 and 16 years of age, with a history of chronic proximal paronychia of the great toe, one of them developing osteomyelitis. After failure of treatment with several systemic antibiotics, nail avulsion was performed, leading us to the diagnosis of retronychia and with rapid and complete resolution of symptoms in both cases. Delay in diagnosis of retronychia can lead to local complications and prolonged discomfort.

Neonatal Acute Paronychia.

BACKGROUND: Paronychia is defined as infection afflicting the eponychial nail folds of the hand or foot. Such infections are rarely reported in the perinatal age group, and not previously described in a neonate younger than 2 weeks. Trauma resulting in inoculation of the nail fold is the most common predisposing factor to paronychia. Oral trauma in the pediatric population from finger sucking predisposes this population to a different set of bacterial pathogens than adults. Contamination can progress to infection and abscess formation within the nail fold with the most prevalent vector in adult infections being Staphylococcus aureus. Comparatively, mixed anaerobic and aerobic infections tend to afflict children with oral soothing habits. METHODS: This is a case report will present the rare occurrence of a paronychia in a neonate caused by methicillin-resistant Staphylococcus aureus. RESULTS: The management and treatment strategies for paronychia in this atypical neonatal patient consisted of incision and drainage and antibiotic therapy. CONCLUSION: Neonates with oral self-soothing behaviors may be more at risk for developing paronychia of mixed anaerobic and aerobic infections. Initial therapy with broad-spectrum antibiotics amoxicillin/clavulanate or clindamycin is suggested. Incision and drainage in the perinatal setting coupled with antibiotics is curative.

Toenail paronychia.

Paronychia is an inflammation of the tissues alongside the nail. It may be acute or chronic and can be seen in isolation or in association with an ingrowing toenail. Acute paronychial infections develop when a disruption occurs between the seal of the nail fold and the nail plate, providing a portal of entry for invading organisms. The treatment of paronychia associated with an ingrowing toenail is aimed at treating the causal toenail. In paronychia not associated with an ingrowing toenail, antibiotics may cure an early infection but surgical drainage of an abscess is often required. In this case, an intra-sulcal approach is preferable to a nail fold incision. Chronic paronychia is less common in the feet than in the hands. It is a form of contact dermatitis and is frequently non-infective, however the chronically irritated tissue may become secondarily colonised by fungi. A dermatology consultation should be obtained for suspected chronic paronychia. Patients with chronic paronychia that is unresponsive to standard treatment should be investigated for unusual causes, such as malignancy. An algorithm for the treatment of paronychia is presented in this review.

Congenital Malalignment of the Great Toenails With Acute Paronychia.

Congenital malalignment of the great toenails (CMGT) has been well documented. In the present case, it was complicated by acute paronychia. It is important for physicians to recognize and treat CMGT to prevent sequelae such as onychocryptosis, onychogryphosis, and recurrent paronychia.

Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis.

Nail disorders are difficult to treat and often frustrating both for patients and clinicians. Because of the slow growth rate of the nail plate and the difficulty of getting the drug actives to penetrate the nail tissues, it is usually necessary to wait several months before seeing the results of treatments. This delay often leads to discontinuation of therapy by the patients. This article therefore helps clinicians to find the right treatment of the 5 most common nail disorders (brittle nails, onycholysis, paronychia, psoriasis, and onychomycosis) and provides practical tips that might improve patients' compliance.