Paronychia is inflammation around a finger or toenail. Paronychia is a nail disease that is an often tender bacterial or fungal infection of the hand or foot, where the nail and skin meet at the side or the base of a finger or toenail. The infection can sta suddenly (acute paronychia) or gradually (chronic paronychia) signs and symptoms: The skin typically presents as red, itchy, and hot, along with intense pain. Pus is usually present, along with gradual thickening and browning discoloration of the nail plate. Causes: *Acute paronychia is usually caused by bacteria. Paronychia is often treated with antibiotics, either topical or oral or both. Chronic paronychia is most often caused by a yeast infection of the soft tissues around the nail but can also be traced to a bacterial infection. If the infection is continuous, the cause is often fungal and needs antifungal cream or paint to be treated. Risk factors include repeatedly washing hands and trauma to the cuticle such as may occur from repeated nail biting. In the context of baending, it is known as bar rot. Prosector's paronychia is a primary inoculation of tuberculosis of the skin and nails, named after its association with prosectors, who prepare specimens for dissection. Paronychia around the entire nail is sometimes referred to as runaround paronychia. Painful paronychia in association with a scaly, erythematous, keratotic rash (papules and plaques) of the ears, nose, fingers, and toes may be indicative of acrokeratosis paraneoplastica, which is associated with squamous cell carcinoma of the larynx. Paronychia can occur with diabetes, drug-induced immunosuppression,or systemic diseases such as pemphigus. Treatment: When no pus is present, warm soaks for acute paronychia are reasonable, even though there is a lack of evidence to suppo its use.Antibiotics such as clindamycin or cephalexin are also often used, the first being more effective in areas where MRSA is common.If there are signs of an abscess (the presence of pus) drainage is recommended. Chronic paronychia is treated by avoiding whatever is causing it, a topical antifungal, and a topical steroid. In those who do not improve following these measures, oral antifungals and steroids may be used or the nail fold may be removed surgically Ref Harrison 20th edition pg 1234