@shubhangi
History
The patient's history is crucial in determining the possibility of systemic conditions and risk factors that may predispose an individual to paronychia. These may include the following:
Diabetes mellitus
Obesity
Hyperhidrosis
Immunologic defects
Polyendocrinopathy
Drug-induced immunosuppression
Retroviral use - Indinavir and lamivudine, in particular, are thought to be associated with an increased incidence of paronychia formation
Patients may give a history of the following :
Nail biting
Finger sucking
Trivial finger trauma
Finger exposure to chemical irritants
Use of acrylic nails or nail glue
Sculpted nails
Frequent hand immersion in water
Also query patients about the duration of symptoms and a history of nail infections and previous treatment.
Because paronychia has been known to initiate from malignant lesions, any history of prior malignancy or a pigmented, irregular appearance of surrounding tissue should result in appropriate suspicion and referral for biopsy.
Painless swelling or severe swelling that radiates requires an expanded differential diagnosis. [29] Painless swelling lateral to the nail plate in a patient with osteoarthritis should prompt investigation for a mucous cyst.
Acute paronychia
The patient is usually otherwise healthy but complains of pain, tenderness, and swelling in one of the lateral folds of the nail.
Chronic paronychia
Generally, patients report symptoms lasting 6 weeks or longer. Inflammation, pain, and swelling may occur episodically, often after an exposure to water or a moist environment.
Chronic and recurrent paronychial infections should be scrutinized to rule out malignancy or fungal infection.