Tumors of the Nails: Nail Disorders: Merck Manual Home Edition [NEW TOPIC PAGES] ► Nail Diseases: MedlinePlus ► Paronychia

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Tumors of the Nails: Nail Disorders: Merck Manual Home Edition

Tumors of the Nails

Benign and malignant tumors can affect the nail unit, causing a deformity. These tumors include noncancerous myxoid cysts, pyogenic granulomas, glomus tumors, Bowen's disease (an early form of skin cancer), squamous cell carcinoma, and malignant melanoma. When doctors suspect cancer, they perform a biopsy and may recommend complete removal of the tumor as soon as possible. Hutchinson's sign—a black discoloration of the area around the nail, including the lunula (half-moon at the base of the nail), cuticle, and nail fold (the fold of hard skin overlapping the sides of the nail)—may mean there is cancer in the nail bed. When this sign is present, doctors perform a biopsy and begin treatment as quickly as possible. Last full review/revision August 2007 by Wingfield E. Rehmus, MD, MPH Nail Diseases     Nail Diseases http://www.nlm.nih.gov/medlineplus/naildiseases.html Nail Diseases: MedlinePlus     Your toenails and fingernails protect the tissues of your toes and fingers. They are made up of layers of a hardened protein called keratin, which is also in your hair and skin. Your nails' health can be a clue to your overall health. Healthy nails are usually smooth and consistent in color. Specific types of nail discoloration and changes in growth rate can signal various lung, heart, kidney and liver diseases, as well as diabetes and anemia. White spots and vertical ridges are harmless. Nail problems that sometimes require treatment include bacterial and fungal infections, ingrown nails, tumors and warts. Keeping nails clean, dry and trimmed can help you avoid some problems. Do not remove the cuticle, which can cause infection. MEDICAL ENCYCLOPEDIA   Aging changes in hair and nails Fungal nail infection Ingrown toenail Nail abnormalities Paronychia Splinter hemorrhages Related Topics Skin, Hair and Nails National Institutes of Health The primary NIH organization for research on Nail Diseases is the National Institute of Arthritis and Musculoskeletal and Skin Diseases Paronychia What Is It? Symptoms Diagnosis Expected Duration Prevention Treatment When To Call a Professional Prognosis Additional Info What Is It? A paronychia is an infection of the skin that surrounds a toenail or fingernail. There are two different types of paronychia, acute and chronic: Acute paronychia. This usually appears as a sudden, very painful area of swelling, warmth and redness around a fingernail or toenail, usually after an injury to the area. An acute paronychia typically is caused by an infection with bacteria that invade the skin where it was injured. The injury can be caused by overaggressive manicuring (especially cutting or tearing the cuticle, which is the rim of paper-thin skin that outlines the outer margins of your nail). It can also result from biting the edges of the nails or the skin around the nails, picking at the skin near the nails or sucking on the fingers. Chronic paronychia. This is an infection that usually develops slowly, causing gradual swelling, tenderness and redness of the skin around the nails. It usually is caused by Candida or other species of yeast (fungus). It often affects several fingers on the same hand. People who are more likely to get this infection include those with diabetes or workers whose jobs constantly expose their hands to water or chemical solvents. Such jobs include bartending, house cleaning, janitorial work, dentistry, nursing, food service, dishwashing and hairdressing. Symptoms An acute paronychia causes throbbing pain, redness, warmth and swelling in the skin around a nail. In some cases, a small collection of pus forms under the skin next to the nail, or underneath the nail itself. Often, only one nail is affected. A chronic paronychia usually causes less dramatic symptoms than an acute paronychia. Typically, the area around the nail is tender, red and mildly swollen; the cuticle is missing; and the skin around the nail feels moist or "boggy." Several nails on the same hand may be affected at the same time. Diagnosis If you have a mild acute paronychia, you usually can make the diagnosis yourself. Look for throbbing pain, swelling and redness in an area of damaged skin around a nail. If you are diabetic, have several affected fingers or toes, or have severe symptoms (pus, fever, severe pain), you must be evaluated by a doctor. In most cases, your doctor can make the diagnosis by examining the affected area. However, if there is an accumulation of pus, the doctor may take a sample of the pus to be tested in the laboratory for bacteria or fungi. Expected Duration How long a paronychia lasts depends on the type of paronychia. With proper treatment, an acute paronychia usually heals within 5 to 10 days. A chronic paronychia may require several weeks of antifungal medication. Even after proper medical therapy, a paronychia may return if you injure the skin again or forget to keep the nail area dry. Prevention To prevent paronychia, try the following: Keep your hands and feet dry and clean. Wear rubber gloves with an absorbent cotton lining if your hands are exposed routinely to water or harsh chemicals. Be gentle when you manicure your nails. Avoid cutting your cuticles or pushing them back. Avoid biting your nails and picking at the skin around your nails. If you have diabetes, keep your blood sugar levels within a normal range by following your diet and taking your medications. Treatment The type of treatment depends on the type of paronychia: Acute paronychia. You can begin treating yourself by soaking the finger or toe in warm water. Do this for at least 15 minutes, 2 to 4 times a day. If your symptoms do not improve with this treatment, or if pus develops near the nail, call your doctor. If you have a moderate or severe paronychia, your doctor will treat it with antibiotics, such as dicloxacillin (Dycill, Pathocil), cloxacillin (Tegopen), trimethoprim-sulfamethoxazole (Bactrim, Septra) or cephalexin (Keftab). You also will be told to elevate the injured finger or toe, and to soak the infected area in warm water two to four times a day. If pus has accumulated near the nail, the doctor will numb the area and drain the pus. If necessary, a small part of your nail will be removed to make sure that the area drains completely. Chronic paronychia. Since most cases of chronic paronychia are caused by fungi, your doctor will treat the infection with antifungal medication that is applied to the skin, such as clotrimazole (Lotrimin, Mycelex) or ketoconazole (Nizoral). You may have to apply the medicine every day for several weeks. You also will be reminded to keep the skin clean and dry. Rarely, in severe cases, you will need to take antifungal drugs or steroids by mouth. When To Call a Professional Call your doctor if you have symptoms of a paronychia and: You have diabetes You have an accumulation of pus near your nail or under it You have a fever The area of redness near your nail begins to spread up your finger You have milder symptoms (tenderness, mild redness, minimal swelling) that last for seven days or more Prognosis With proper treatment, the outlook is usually very good. In most cases, an acute paronychia heals within 5 to 10 days with no permanent damage to the nail. Rarely, very severe cases may progress to osteomyelitis (a bone infection) of the finger or toe. Although a chronic paronychia may take several weeks to heal, the skin and nail usually will return to normal eventually. However, you must remember to apply medication as directed, and to keep the affected area dry. Additional Info National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Insitutes of Health 1 AMS Circle Bethesda, MD 20892-3675 Phone: 301-495-4484 Toll-Free: 1-877-226-4267 Fax: 301-718-6366 TTY: 301-565-2966 http://www.niams.nih.gov/ American Academy of Dermatology P.O. Box 4014 Schaumburg, IL 60168-4014 Phone: 847-240-1280 Toll-Free: 1-866-503-7546 Fax: 847-240-1859 http://www.aad.org/ American College of Foot and Ankle Orthopedics and Medicine 5272 River Road, Suite 630 Bethesda, MD 20816 Phone: 301-718-6505 Toll-Free: 1-800-265-8263 Fax: 301-656-0989 http://www.acfaom.org/