A chronic paronychia occurs from recurrent episodes of inflammation or from neglected infections. It is much more difficult to treat and eradicate than an acute infection. A chronic paronychia is seen frequently in immunosuppressed patients, such as those with diabetes or cancer. These effects are due to the disease process, such as in diabetes, or due to effects of treatment, as seen with certain HIV drugs and chemotherapeutic agents.12 A chronic paronychia is also common in people who wash their hands often, such as dishwashers and healthcare providers. It can also be due to frequent contact with chemicals, finger biting or sucking, and cuticle trimming. The most frequently isolated organism is C. albicans, which commonly coexists with S. aureus.5,6 Initial treatment typically includes avoiding the noxious exposure, topical emollients, and antifungals.13 Definitive treatment for a chronic paronychia is eponychial marsupialization. This involves removal of a crescent-shaped piece of skin proximal to the nail fold and parallel to the eponychium, extending from the radial to ulnar borders. In addition to marsupialization, complete or partial nail removal may be necessary if nail ridging is present.9 A chronic paronychia may be confused with another condition that looks similar and mimics a chronic paronychia such as cysts, foreign body reactions, malignancies, psoriasis, and verrucae. Refer all chronic paronychia to a Hand Surgeon due to the higher rate of recurrence, the complexity in management, and where follow-up care can be more consistent.