The nail is a complex skin structure composed mainly of the nail matrix, the nail plate, the nail bed, the cuticle (eponychium) and the nail folds. the nail. The cuticle is an outgrowth of the proximal fold, located between the skin of the finger and the nail plate, providing a seal against external irritants and pathogens. Paronychia is an inflammatory reaction of one or more of the three nail folds, the proximal or lateral ones, surrounding the fingernails or toenails. It is most often divided into acute and chronic. Acute paronychia by definition lasts less than six weeks and is usually associated with inflammation following minor trauma, whereas chronic paronychia lasts more than six weeks and can occur either independently or as a result of acute paronychia. Acute paronychia is most often caused by a direct or direct cause. indirect trauma to the cuticle. Such trauma may be minor and result from routine procedures, such as dishwashing, splinter or thorn injury, onychophagia (nail biting), finger sucking, biting or scratching of fingers. toenail, ingrown toenail, artificial nail application, manicure procedures, or other nail manipulation. This type of trauma allows bacterial inoculation of the nail and the resulting infection, with Staphylococcus aureus being the most common pathogen, although Streptococcus pyogenes, Pseudomonas or Proteus can also cause paronychia. Other Gram-negative anaerobic bacteria may also be involved, in the event that the trauma is exposed to oral flora. Except for bacterial infection, acute paronychia can also occur as a manifestation of other disorders affecting the extremities, such as pemphigus vulgaris. Acute paronychia is clinically characterized by the rapid onset of erythema, edema, and tenderness of the proximal midsection. of paper......a comedone extractor, providing rapid pain relief.12 Another simple technique for draining a paronychial abscess is to lift the nail fold with the tip of a needle, followed immediately passive oozing of pus from the nail bed.24 If there is no clear response after a few days, a deeper surgical incision under local anesthesia (digital nerve block) may be necessary. 8,10,11 The proximal third of the nail plate can be removed without initial incisional drainage. 8,17,19 The physician should be very careful with complicated infections that may occur in immunocompromised patients, such as diabetic patients.11,16 Incision and drainage is also contraindicated in patients with herpetic whitlow . In these cases, suppressive therapy with 5% acyclovir ointment or cream or an oral antiviral agent such as acyclovir, famciclovir, or valacyclovir has been suggested...15