A 20-year-old female presented with severe nodulocystic acne was put on Isotretinoin (Roaccutane) 40 mg capsule per day. Two months later with dramatic improvement in acne she presented with painful lateral nail folds paronychia confined to the middle fingers of both hands. Paronychia is an infection of one or more nail folds, usually with Staphylococcus aureus. It can be particularly stubborn and resistant to treatment but settles once the isotretinoin has been discontinued.