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Paronychia

Paronychia or CANTENGAN is an inflammatory reaction of the folds of skin and tissue around the nail. Acute paronychia most often caused by bacterial infection, usually Staphylococcus aureus or Pseudomonas aeruginosa, whereas chronic paronychia caused by the fungus Candida albicans.

Paronychia is characterized by nail into soft tissue, and swelling and can secrete pus (pus), nails grow thicker, discolored, and forming the back line, the transverse. When the infection was chronic, then there is a bright horizontal at the base of the finger nails usually affects 1-3.
       This disease develops in people who are old hands submerged in water, when the finger was injured only slightly, the bacilli or fungi will damage the tissue around the nail. People with diabetes or malnutrition more easily attacked.
More common in women, the disease sometimes appears in children, especially those fond of sucking her fingers. Each finger can be affected, but more often is the ring finger and little finger

CLINICAL MANIFESTATIONS
A. Acute paronychia
       Frequent cause of acute paronychia is Staphylococcus aureus, (80%) while the rest are Streptococcus and other gram-negative bacteria. Superficial paronychia appears as an area of ​​redness, tenderness around the nail fold, swelling, presence of abscess or intra kutikular sub kutikular and also on the lateral nail fold. Paronychia is in providing a picture of tender swelling and cellulitis in almost all tissues proximal to the nail, most often in eponikium. At the beginning before the antibiotic treatment, no visible pus and after treatment of localized pus will form. Bacterial infection of the nail fold often occur secondary to trauma such as sucking and nail biting, nail kesusuban or punctured, the old wounds and nail care is wrong with the use of unsterilized equipment that may lead to tearing of the cuticle

B. Chronic paronychia
     Based on the etiology divided into primary and secondary. In the primary state of pain and swelling of existing lateral and posterior nail fold, erythematous looks shiny. The cuticle is usually separated from the nail plate which is an important diagnostic picture.
      In the early stages of the nail plate still looked normal; to further process the plate in the proximal and lateral nail discoloration even dystrophy. The disease is more common in women, especially at the age of 30-60 years. Sometimes occurs in children who love to suck his fingers.
    Etiology associated with hand immersion in water for long. The disease is more common in housewives, cooks, nurses, people with jobs related to fishing such as fishermen, fish sellers, workers canteen (catering), which is a predisposing systemic disease such as diabetes (DM).
      Mild inflammation that persists in the nail fold is often followed by acute attacks of spots formed pus that can be known with an emphasis nail fold tissue will exit the material are like cheese. Pus is formed in a bag under the nail fold; no visible abscess in perinychium.
     Acute attacks and chronic repeated cause discoloration of the nail plate and the lateral proximal part such as yellow, brown or blackish. This discoloration is caused by an organism resulting dihydroxy acetone in the nail fold. Pseudomonas gives a special color of green or blue depending on the species of Pseudomonas. Pseudomonas pyocyanea give a green color because the pigment piosianin, while the green color of Pseudomonas aeruginosa.
Candida paronychia have the following signs:
1. Painless.
2. In the palpability less warm, compared with bacterial paronychia.
3. The absence of pus or pus.
4. Chronically runs.
5. Often accompanied onikolisis
        On Candida paronychia, the nail plate is affected secondarily. Darker the nail plate, convex, sometimes thinner, there is rarely a sub ungual hyperkeratosis. While the clinical nail candidiasis is characterized by sub-ungual hyperkeratosis. Clinical picture of nail candidiasis is difficult to distinguish from tinea unguium.
        The differences can be detected by culture in the presence of the fungus Candida fungus and treatment response is not well with griseofulvin. Whereas in tinea unguium, the cause of dermatophyte fungi growing culture, improving the response to treatment with griseofulvin.
      In the secondary paronychia, nail infections are usually caused by: Hendersonula toruloidea or Scytalidium hyalinum. The mechanism of chronic paronychia Secondary paronychia is similar to the primary. The first interruption of eponikium loss of the nail plate due to immersion in water for long. Exposure causes the cuticles soft and finally escape, resulting in the invasion of bacteria and fungi.

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