What conditions should be included in the differential diagnosis of paronychia?

Updated: Oct 09, 2020
  • Author: Elizabeth M Billingsley, MD; Chief Editor: William D James, MD  more...
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Conditions to consider in the differential diagnosis of paronychia include the following:

  • Candidiasis

  • Dyshidrotic eczema

  • Felon

  • Hand infections

  • Herpetic Whitlow

  • Psoriasis

  • Bowen disease [34]

  • Kaposi sarcoma

  • Malignant melanoma

  • Pemphigus vulgaris [35, 36]

  • Pyogenic granuloma

  • Reactive arthritis

  • Splinters, foreign body

  • Mucous cyst

  • Subungual fibroma

  • Glomus tumor

  • Blastomycosis

Herpetic whitlow is a viral infection of the pulp of the fingertip and the perionychium that can often be confused with the more common acute bacterial paronychia. Clear vesicles that are grouped on an erythematous base are characteristic of herpetic whitlow. Herpes simplex virus 1 causes approximately 60% of cases of herpetic whitlow, and herpes simplex virus 2 causes the remaining 40% of cases.

Malignancies, such as melanoma and squamous cell carcinoma, or lesions, such as chancres, granulomas, warts, or cysts, can occasionally mimic a paronychia. [37, 38]

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