How can I differentiate between acute and chronic paronychia in a primary care setting?

Acute paronychia typically presents with rapid onset of pain, redness, swelling, and sometimes pus around the nail fold, often following minor trauma or exposure to moist environments. It may show a fluctuant pus collection or abscess, which can require incision and drainage. Systemic symptoms like fever or cellulitis may be present in severe cases. Management includes warm soaks, topical or oral antibiotics, and possibly drainage if abscess forms. It usually resolves within days to weeks with appropriate treatment.

Chronic paronychia, in contrast, is characterized by inflammation of the nail fold lasting more than 6 weeks, often without an acute pus collection. It is commonly associated with repeated exposure to irritants or moisture, leading to chronic inflammation rather than infection. The nail fold may appear swollen, red, and tender but without the acute signs of abscess. Chronic paronychia often involves cuticle loss and nail dystrophy.

In primary care, differentiation is based on duration and clinical features:

• Acute paronychia: rapid onset, pain, swelling, erythema, possible abscess, often with pus and systemic symptoms.
• Chronic paronychia: symptoms persisting >6 weeks, less likely to have pus or abscess, associated with chronic irritation, cuticle changes, and nail dystrophy.

History of exposure to moist environments or irritants and absence of acute infection signs support chronic paronychia diagnosis. If uncertain, consider referral or further assessment.

This differentiation guides management, as acute paronychia may require antibiotics and drainage, whereas chronic paronychia focuses on avoiding irritants and managing inflammation.