The Woes of Taking Accutane: Skin & Nail Infections

My husband is on isotretinoin (commonly known as Accutane), which as most users will understand, dries you the eff out. He’s never had dry skin in his life, so he is understandably freaked out by it. As I’ve lived with dry skin my whole life, I was all too happy to help him out by suggesting lotions and creams. It’s worse than I’m making it seem, like, semi-harlequin-itis scaly dry skin worse. I couldn’t deal with that very well. Well, if you’ve taken Accutane for severe acne like unrelenting acne nodules and cysts, you know what I’m talking about.

But then we came across a new thing neither of us had ever seen before. The side of his nail on his index finger was… in so many words… pulling away from the nail. At first, I thought it was one of those dry winter skin cuts that you get this time of the year. Where the skin cracks and omg pain. But no, this was swollen and red, and the dry skin was thick and hard. It was sensitive to touch, and it just hurt all the time, not just when you touched it. It started to look infected, we could see yellow pus, so we went into the urgent care to get it checked out.

Come to find out, it’s Paronychia. And it is not uncommon for people taking Accutane to come down with it, because the skin is so dry it is susceptible to germs and infections. Paronychia can get really bad if left untreated. Like, get your nail taken off bad because an abscess has formed underneath and it needs to drain. And I cringe at anything harming nails. Gross.

Known Accutane Side Effect: What is Paronychia?

Paronychia is an infection of the perionychium, or the skin that hangs over the side of the nail. It is the most common hand infection in the United States. Paronychia is seen frequently in children as a result of nail biting and finger-sucking, and is a side effect of taking isotretinoin. Paronychia is divided into acute paronychia and chronic paronychia depending on the amount of time the infection has been present.

Both acute and chronic infections start with a break in the epidermis. An acute infection is associated with trauma to the skin such as a hangnail, ingrown nail, or nail-biting. The most common bacteria responsible is Staphylococcus aureus. Other bacteria that are less commonly involved are Streptococcus species and Pseudomonas species. A chronic infection is associated with repeated irritation such as exposure to detergents and water. Most chronic infections are caused by Candida albicans or other fungi.

Appearance of Acute Paronychia

Acute paronychia starts as a red, warm, painful swelling of the skin around the nail. This may progress to the formation of pus that separates the skin from the nail. Lymph nodes in the elbow and armpit may swell.

Appearance of Chronic Paronychia

In chronic paronychia, the redness and tenderness are less noticeable than the acute infection. The skin around the nail can get boggy. The nail may have a green discoloration due to Pseudomonas infection.

Diagnosis of Paronychia

Paronychia is diagnosed based on clinical symptoms. Sometimes if there is pus involved, a culture may be taken to determine the bacteria involved. This is not absolutely necessary since the bacteria can usually be assumed to be a Staphylococcus or Streptococcus species. Chronic paronychia is more difficult to diagnose. A potassium hydroxide (KOH) test of a smear from the nail fold can sometimes reveal a fungus.

Treatment of Paronychia

Warm soaks can be used 3 or 4 times a day for acute paronychia to promote drainage and relieve some of the pain. Most cases of acute paronychia should be treated with antibiotics such as cephalexin or dicloxacillin. Topical antibiotics or anti-bacterial ointments do not effectively treat paronychia. If there is pus or an abscess involved, the infection may need to be incised and drained. Rarely, a portion of the nail may need to be removed.

Chronic paronychia is treated with topical anti-fungal medication such as ketoconazole cream. A mild topical steroid like hydrocortisone may be added to the anti-fungal medication to help reduce inflammation. Steroids should never be used alone on a chronic paronychia.

Well, my husband got an antibiotic and he soaked his hand in warm water, and you can see the difference. Luckily, there was no harm done to the nail. It’s intact. Whew.

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