Hair and Nail Manifestations of HIV Infection
Clay J. Cockerell, Antoanella Calame in Cutaneous Manifestations of HIV Disease, 2012
Paronychia refers to a soft tissue infection or inflammation of the epidermis around the nail plate. In the non-HIV-infected population chronic paronychia is usually caused by contact irritants or repeated exposure to water. In HIV-infected patients, the protease inhibitor indinavir is thought to be the most common cause of chronic paronychia,109 followed by onychomycosis and candidal infections. Although a direct cause–effect relationship has yet to be established between indinavir and paronychia, when it has been discontinued, it has been noted that the paronychia has either resolved or diminished in intensity, findings which are strongly suggestive of such a relationship.110–112 Garcia-Silva et al. reported paronychia in 4–9% of HIV patients receiving indinavir,109 and in a retrospective study by Colson et al., indinavir treatment was significantly associated with a 4.7-fold increased risk of great toe paronychia.113 Similar nail changes have also been reported in HIV-infected patients taking lamivudine114 and AZT,115 albeit less frequently.
Infections and infestations affecting the nail
Eckart Haneke in Histopathology of the NailOnychopathology, 2017
Paronychia is a relatively common condition due to various infections, trauma, and foreign bodies. Whereas the diagnosis of candidal paronychia used to be made in most chronic and repeatedly recurring paronychias until some 20 years ago, it is now believed that most of these cases are primarily due to allergies, predominantly of the immediate type to various foods. However, there are undoubted cases of fungal infections215 that also respond to pure antimycotic treatment. The nail fold is thickened, its free end is rounded, the cuticle is lacking, and there is a split formation between the proximal nail fold and the underlying nail plate. This allows foreign substances including bacteria and fungi to enter and be trapped. It is possible that the resulting close contact with these substances under the nail fold facilitates sensitization.
Psoriasis of the Nails
John Y. M. Koo, Ethan C. Levin, Argentina Leon, Jashin J. Wu, Mark G. Lebwohl in Mild to Moderate Psoriasis, 2014
Red spots in the lunula are seen when the distal matrix is affected [2]. When the nail bed alone is affected, then “oil spots” [17], nail bed hyperkeratosis, and splinter hemorrhages [18] are common. Oil spots, also known as “salmon patches,” refer to a yellow-orange discoloration due to psoriasis of the nail bed (Figure 16.3) [19]. Splinter hemorrhages are due to trauma and are analogous to the Auspitz sign associated with cutaneous psoriasis [10] (Figure 16.3a). Leukonychia is caused by midmatrix disease. The whitish areas are likely due to adherent foci of parakeratotic cells that cannot be dislodged. Onycholysis is a distinct phenomenon that results from separation of the nail bed from the plate (Figure 16.4). The separation begins distally and progresses proximally toward the matrix. The plate appears whitish rather than yellow due to trapped air beneath it. It is usually surrounded by a reddish hue [10] and is distinguished from true leukonychia by location. Leukonychia is usually seen on the proximal portion of the plate whereas onycholysis appears distally. Proximal nail fold plaques are marked by classic cutaneous psoriasis with silvery scales over a red base [2]. This may present as chronic paronychia [11].
The ambulatory care burden of nail conditions in the United States
Published in Journal of Dermatological Treatment, 2021
Shari R. Lipner, Julie E. Hancock, Alan B. Fleischer
The age range of visit that most frequently presented with nail complaints was 45–64 (6.2 [5.1–7.3] million visits), followed by 25–44 (5.7 [4.5–6.9] million visits) (Figure 1). The other age groups had fewer visits involving nail complaints and nail diagnoses. The diagnoses with the most variable age group differences were paronychia of toe, paronychia of finger, and dermatophytosis of nail (Figure 2). Paronychia of toe was most commonly diagnosed in the age ranges 0–14 (424 [153–696] thousand visits) and 15–24 (464 [117–811] thousand visits). Paronychia of finger was most commonly diagnosed in the age ranges 0–14 (371 [95.7–647] thousand visits) and 45–64 (323 [116–531] thousand visits). Dermatophytosis of nail was primarily diagnosed in ages 25–44 (3.42 [2.49–4.35] million visits) and 45–64 (3.47 [2.65–4.29] million visits).
Safety of EGFR-TKIs for EGFR mutation-positive non-small cell lung cancer
Published in Expert Opinion on Drug Safety, 2020
Jia-Ying Zhou, Si-Yang Liu, Yi-Long Wu
The pathogenesis of paronychia is unclear; it occurs most frequently 4–8 weeks after commencement of treatment with EGFR-TKIs, can affect any fingernail or toenail, and is inconvenient to the patient [47]. We recommended that patients avoid trauma to the nail (e.g. biting the nail, tearing the skin around the nail, and clipping the nails too short) because this can exacerbate paronychia. In addition, topical steroids should be avoided. When there is too much granulation tissue around the nail groove, silver nitrate may be applied as required. Bacterial culture and antibiotic treatment should be performed in cases in which the appearance of the skin indicates repeated bacterial infection [46].
Optimal diagnosis and management of common nail disorders
Published in Annals of Medicine, 2022
Debra K. Lee, Shari R. Lipner
Paronychia is defined as inflammation or infection of the proximal or lateral nail folds. This condition can be classified into acute, chronic or chemotherapy-associated paronychia (CAP) based on duration of symptoms and aetiology [47,48]. Infections are responsible for the acute subtype, while irritants and allergens are common causes of chronic paronychia [49]. Certain chemotherapeutic agents are responsible for CAP. Nevertheless, all subtypes involve a breach in the protective barrier in the nail fold. Women are more commonly affected than men. Common risk factors include trauma, use of artificial nails and manicuring, ingrown nails and nail biting [49].
Related Knowledge Centers
- Candida Albicans
- Edema
- Incision & Drainage
- Whitlow
- Staphylococcus Aureus
- Herpetic Whitlow
- Nail Biting
- Hangnail
- Incision & Drainage
- Ring Finger
- Phalanx Bone