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Paronychia (Infection Beside the Nail)

49 citationsUpdated Oct 2026
Illustration: Paronychia (Infection Beside the Nail)

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Overview

Paronychia is an infection of the nail fold, with Staphylococcus pyogenes and Candida albicans frequently cultured from affected tissue in chronic cases [1]. While fungal infections of the hand most commonly present as cutaneous involvement of the skin and nails [12], the role of Candida in chronic paronychia is distinct; eradication of Candida is not associated with clinical cure in most patients, indicating it acts primarily as a colonizer of the proximal nail fold rather than a primary pathogen [7]. Although infections caused by Candida parapsilosis alone respond well to terbinafine, this agent is not as effective in candidal nail disease overall [14]. Chronic keratinaceous paronychia should be regarded as a potential complication of nail biting [3].

Complicated paronychia and hand infections are more frequent than expected, occurring in 33% of cases, and are often iatrogenic [4]. Surgical correction is indicated for nail deformities caused by congenital anomalies, tumors, and infection, which can frequently be corrected or improved surgically [9]. However, outcomes are less favorable when associated with specific injury patterns; poorer results occurred with crush or avulsion injuries, injuries of both the nail bed and nail fold, and with associated infection [38].

Anatomy & Pathophysiology

Definition and Etiology

Paronychia is defined as an inflammation of the tissue surrounding the nail plate [23] and constitutes a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet [44]. Acute paronychia resembles acute cellulitis at other sites and is usually of streptococcal or staphylococcal origin arising from a "hangnail" or trauma [23]. The most commonly cultured organism in acute paronychia is Staphylococcus aureus [44]. In contrast, Candida species are responsible for chronic or recurrent paronychia, a condition more prevalent in women working in moist environments and those patients who work under water [28]. Chronic paronychia is most commonly an environmental disease resulting from an impairment of the epidermal barrier of the proximal nail fold [24]. The first step in its development is always a mechanical or chemical trauma that produces cuticle damage [24]. Cuticle injury can result from manicuring, occupational trauma, frequent handwashing, continuous exposure to water, and/or irritative compounds [24]. When the cuticle is damaged or lost, the epidermal barrier of the proximal nail fold is destroyed and the proximal nail fold is exposed to environmental hazards [24]. Irritants and allergens may then penetrate the proximal nail fold to produce an inflammatory reaction of the nail fold and nail matrix [24]. This inflammatory reaction interferes with normal nail growth and the formation of a new cuticle [24]. Chronic paronychia should no longer be considered a mycotic disease but an eczematous condition with multifactorial etiology [15]. Accumulating evidence indicates that in most cases chronic paronychia represents a clinical variety of contact urticaria [24].

Anatomical Pathophysiology

Chronic paronychia comprises two basic components: a pocket which holds moisture and allows the survival of many different organisms, and an anatomic deformity of rounding out and retraction of the posterior nail fold [23]. This anatomic deformity is caused by foreign material in the dermis [23]. The resulting dermal change with subsequent rounding out and retraction assures the continuing presence of the moisture-holding pocket [23]. Maceration of the posterior nail fold allows the passage of foreign material into the dermis of the fold and incites a chronic inflammatory reaction [34]. Sterile maceration did not produce the changes of chronic paronychia when prolonged for three to six months [34]. The addition of hemolytic streptococci, Proteus mirabilis, Proteus morganii, E. coli, and Pseudomonas aeruginosa to occluded nail folds seemed to speed maceration, but the final lesion produced did not differ significantly from those resulting from simple maceration [34]. Conversely, the retraction and rounding out phenomenon was repeatedly reproduced when C. albicans was added to the fold and occluded for 30 days [34]. Candida albicans may contribute to the development of the lesion by destroying the epidermal barrier rather than by supplying the foreign material [34]. Monilia contribute to the disease process by irritation on the surface and by penetration of debris into the dermis [23]. Debris stimulates chronic inflammation which in turn often aggravates the original defect [23].

Clinical Presentation and Demographics

Chronic paronychia almost exclusively affects adult women [24]. Paronychia is more common in women than in men, with a female-to-male ratio of 3:1 [44]. In adults, chronic paronychia is very gradual in onset and often begins with a swelling and separation of the lateral nail fold from the side of the nail [23]. Some adults will have only one side of the posterior nail fold involved after the lesion has been present for several years [23]. In children, chronic paronychia lesions are generally prominent, with total involvement of the posterior nail fold [23]. In children, the lesion appears as a marked rounding out and retraction of the posterior nail fold, and thick pustular material can often be expressed from the pocket under that fold [23]. Thumb-sucking is the most frequent predisposing factor of chronic paronychia in children [23]. Chronic paronychia is clinically characterized by a chronic inflammation of the proximal nail fold with or without nail plate abnormalities [24]. The condition usually has a prolonged course interspersed with recurrent self-limited episodes of acute exacerbations [24]. If paronychia is neglected, pus may spread under the nail sulcus to the opposite side, resulting in a "run-around abscess" [44]. Pus may also accumulate beneath the nail itself and lift the plate off the underlying matrix [44]. Immunosuppressive states and systemic diseases such as diabetes can alter the causative organisms and the intensity of treatment required [44].

Classification

Paronychia is classified primarily by clinical presentation and etiology rather than a single standardized grading system. The condition is divided into acute and chronic forms, each with distinct pathophysiological origins and clinical features.

Acute Paronychia: Acute paronychia is clinically similar to acute cellulitis at other sites and is usually of streptococcal or staphylococcal origin [23]. It typically arises from a "hangnail" or trauma [23]. It is rare for an acute lesion to be followed by a chronic paronychia [23].

Chronic Paronychia: Chronic paronychia is characterized by a chronic inflammation of the proximal nail fold with or without nail plate abnormalities [24]. In adults, the onset is very gradual and often begins with swelling and separation of the lateral nail fold from the side of the nail [23]. In children, the lesion appears as marked rounding out and retraction of the posterior nail fold [23]. The underlying cause is generally agreed to be prolonged exposure to cold water, allowing Candida and Pseudomonas species to act as opportunist pathogens [27]. However, mechanisms of infection, trauma, and prolonged immersion of the hands in water are not sufficient to explain the chronic forms of the disease [16]. Candida eradication was not associated with clinical cure in most patients, indicating that Candida is just a colonizer of the proximal nail fold [7].

Etiology and Predisposing Factors: The first step in the development of chronic paronychia is mechanical or chemical trauma that produces cuticle damage [24]. Cuticle injury can result from manicuring, occupational trauma, frequent handwashing, or continuous exposure to water and irritative compounds [24]. Consequently, chronic paronychia is most commonly an environmental disease resulting from an impairment of the epidermal barrier of the proximal nail fold [24]. Thumb-sucking is the most frequent predisposing factor for chronic paronychia in children [23]. Chronic paronychia should be regarded as a potential complication of nail biting [3]. Chronic keratinaceous paronychia is a distinct entity associated with nail biting [3].

Pathophysiology and Complications: The dermal change with subsequent rounding out and retraction assures the continuing presence of the pocket in chronic paronychia [23]. Chronic monilial disease usually localizes at sites of pre-existing defects [23]. The debris from monilial infection stimulates chronic inflammation which often aggravates the original defect [23]. Complicated paronychia and hand infections are more frequent than expected, occurring in 33% of cases [4]. These complicated infections are often iatrogenic [4].

Clinical Presentation

Paronychia is a common inflammatory condition of the nail fold often associated with infection [68]. Etiologies include fungal, viral, or most commonly bacterial causes [68]. Neonatal paronychia is a rare presentation, with only one previously reported case in the literature involving a patient younger than 1 month of age [68].

Acute Paronychia

Acute paronychia usually arises from a "hangnail" or trauma and is of streptococcal or staphylococcal origin [23]. The typical presentation involves a tender, swollen, and erythematous eponychium with a purulent collection under the nailfold but not under the nail plate itself [22]. Erythema does not extend proximal to the distal interphalangeal joint [22]. Radiographs are normal except for soft tissue swelling dorsally in the region of the infection [22].

Chronic Paronychia

Chronic paronychia presents with erythema, swelling, and pain, although the degree of erythema and swelling is often less than that associated with acute paronychia [32]. Symptoms are generally present for 6 weeks at the time of diagnosis [32]. Episodic exacerbations may occur, often following exposure to moist environments [32]. The proximal nail fold may become raised and separated from the underlying nail [32]. Associated nail changes include ridging, grooving, discoloration, and/or rounding of the nail plate [32].

In children, the lesion appears as marked rounding out and retraction of the posterior nail fold, with thick pustular material often expressible from the pocket under that fold [23]. Cuticle injury can result from manicuring, occupational trauma, frequent handwashing, or continuous exposure to water and/or irritative compounds [24]. The mechanisms of infection, trauma, and prolonged immersion of the hands in water are not sufficient to explain the chronic forms of the disease [16].

Two basic components characterize chronic paronychia: a pocket which holds moisture and allows the survival of many different organisms, and an anatomic deformity of rounding out and retraction of the posterior nail fold due to foreign material in the dermis [23]. The dermal change with subsequent rounding out and retraction assures the continuing presence of the pocket [23]. This debris stimulates chronic inflammation, which in turn often aggravates the original defect [23]. Strong and weak concentrations of primary irritants produced erythema and ridging of the nail without the rounding out of the fold [34]. The addition of hemolytic streptococci, Proteus mirabilis, Proteus morganii, E. coli, and Pseudomonas aeruginosa to occluded nail folds seemed to speed maceration, but the final lesion produced did not differ significantly from those resulting from simple maceration [34].

All patients in a study of chronic paronychia had a positive culture for C. albicans from the nail fold before biopsy [67]. Cultures from the dermis of the paronychia were all negative, and there was no yeast growth on any of the bacterial cultures taken from these areas [67]. Chronic paronychia responds slowly to treatment and may take several weeks or months [15]. If untreated, painful episodes of acute inflammation may be experienced as a result of continuous penetration of various pathogens [15].

Atypical and Complicated Presentations

Further diagnostic testing may be warranted in atypical cases of chronic paronychia in which malignancy or systemic etiologies are suspected [32]. The clinical differential diagnosis of a new periungual or subungual lesion (with or without an associated nail plate dystrophy) should include tumor metastasis to the nail unit not only in oncology patients, but also in previously cancer-free individuals [13]. Physicians should consider squamous cell carcinoma of the nail unit in each case of a nail abnormality unresponsive to topical treatment [37]. A patient with Kaposi's sarcoma in the hand of an AIDS patient presented with what appeared to be a chronic paronychia [35].

Complicated paronychia and hand infections are more frequent than expected (33% of cases) and often iatrogenic [4]. The combination of persistent, active inflammation, compromised vasculature, poor hand hygiene, poor healing and a reluctance to seek treatment may allow paronychia to evolve and erode into the joint space [19]. Atypical hand infections are difficult to recognize and treat due to their indolent nature and nonspecific symptoms [83].

Investigations

Hand and upper-extremity infections are usually a clinical diagnosis, but imaging and laboratory evaluation aid in diagnosis [47].

Plain radiography: Radiographs are typically normal, except for some soft tissue swelling dorsally in the region described in a case of acute paronychia [22]. Early osteomyelitis of the bone can be detected long before the roentgenogram reveals evidences of destruction [117]. In a case of metastatic bronchogenic carcinoma masquerading as a felon, the diagnostic consideration of neoplasm was entertained only after cortical destruction was present on later roentgenographs [118].

Other Considerations: Physicians should consider SCCNU in each case of a nail abnormality unresponsive to topical treatment [37].

Treatment

Non-Operative

Conservative management is the primary approach for acute paronychia in the absence of pus under the nail or in the nailfold, typically involving oral anti-staphylococcal antibiotics with or without warm saline soaks [22]. Advocates of warm soaks posit that heat encourages the spontaneous drainage of occult pus [22]. For early paronychia, a conservative method of lifting the cuticle and inserting a sterile rubber ribbon can arrest and cure the condition in a few days without nail removal [39]. Chemical sealing using cyanoacrylate glue heals the gap between the proximal nail fold and nail plate within 6–8 weeks, providing relief from chronic paronychia [6].

Chronic paronychia requires preventive measures as the main part of therapy [15]. Topical steroids play a major role in therapy and are more effective than systemic anti-fungals (level of evidence B) [15]. Tacrolimus has recently shown promising results in the treatment of chronic paronychia [15]. Fungal infections of the hand can be treated with topical or local therapy [12]. In a small number of patients treated for chronic paronychia, all improved at the same rate, probably because the care of the nail folds is more important than the medication applied [21].

Specific pharmacological and physical agents have demonstrated efficacy. Nineteen of 29 patients (65.5%) in Cohort B reported moderately or very painful nails at baseline that decreased to five patients (17.2%) at visit 3 in a trial of a novel topical povidone-iodine formulation [8]. Chronic paronychia required on average 20.4 ± 18.32 days of therapy to reach the treatment endpoint using low-level laser therapy [18]. Fifty-nine patients with proved monilial paronychia were treated with the nail polish sealer method [20]. Additionally, 50 mg/day fluconazole is both effective and safe in the management of chronic paronychia [36].

Operative

Indications: Surgical therapy should be resorted to in recalcitrant cases of chronic paronychia [15]. The author believes that a simple procedure should be tried first in almost every case, as many patients may be cured without recourse to nail removal [10]. En bloc excision of the proximal nail fold is a useful method in recalcitrant chronic paronychia [2]. The square flap technique was employed for exuberant chronic paronychia with involvement of all digits and an unsatisfactory response to clinical therapies [71].

Surgical Approach / Technique: In cases of complicated paronychia, thorough excision is essential [30]. The Swiss roll technique is a simple method for the treatment of chronic and severe acute paronychia with run around infection involving both nail folds [26]. The square flap technique cured paronychia in all but 2 cases, measured by cuticle regrowth [31]. A single case of severe paronychia was treated by burning holes through the nail with a heated wire to drain pus, resulting in instant relief and the patient returning to full duty by the fifth morning [5].

Adjuncts: Simultaneous nail removal augments the results in most cases of chronic paronychia [15]. Nail removal should be performed when concurrent nail irregularities are seen in the surgical treatment of chronic paronychia [17]. In a prospective study of 46 patients with acute felon and paronychia, antibiotics were not necessary after surgical treatment [43]. Conversely, empirical antibiotic therapy with amoxicillin–clavulanic acid is appropriate in cases of complicated paronychia [30].

Other Considerations: The study reports on 26 patients treated for paronychia granulomatosa [111].

Complications

General Infection Risks: Hand infections carry a high rate of complications that are often difficult to manage [102]. If chronic paronychia remains untreated, continuous penetration of various pathogens results in painful episodes of acute inflammation [15].

Joint Erosion: In patients with thromboangiitis obliterans, atypical chronic sterile paronychia can evolve and erode into the joint space [19]. This progression may occur when persistent active inflammation, compromised vasculature, poor hand hygiene, poor healing, and reluctance to seek treatment combine to allow the infection to invade the joint [19].

Chronic Morphological Changes: In children, chronic paronychia is characterized by total involvement of the posterior nail fold, marked rounding out and retraction of the posterior nail fold, and thick pustular material expressed from the pocket under that fold [23]. In adults, the condition often begins with swelling and separation of the lateral nail fold from the side of the nail, with some patients having only one side of the posterior nail fold involved after the lesion has been present for several years [23]. The proximal nail fold may become raised and separated from the underlying nail [32].

Nail Plate and Cuticle Alterations: Chronic paronychia is characterized by a chronically indurated and rounded or bolstered cuticle, recurring episodes of increased inflammation, drainage, and eventual thickening and longitudinal grooving of the nail plate [80].

Other Considerations: Candida and nondermatophyte infections often involve the surrounding nail folds, causing paronychia in addition to nail plate disease [33].

Recovery

Non-Operative Management: A simple procedure should be tried first in almost every case, as many patients may be cured without recourse to nail removal [10]. In the treatment of chronic paronychia, the care of the nail folds is more important than the medication applied [21]. When treated with low-level laser therapy (LLLT), chronic paronychia required on average 20.4 ± 18.32 days of therapy to reach the treatment endpoint [18]. Following chemical sealing with cyanoacrylate glue, the gap between the proximal nail fold and nail plate heals and fills up within 6–8 weeks, providing relief from chronic paronychia [6]. Regarding pain reduction, nineteen of 29 patients (65.5%) in Cohort B reported moderately or very painful nails at baseline that decreased to five patients (17.2%) at visit 3 following treatment with a novel topical povidone-iodine formulation [8].

Operative Management: During surgical treatment of paronychia, tissues appearing infected are widely excised while preserving as much of the nail matrix as possible [43]. Antibiotics are not necessary after surgical treatment for acute felon and paronychia in patients without complications or at-risk conditions [43]. In a single case of severe paronychia, the condition was treated by burning holes through the nail with a heated wire to drain pus, resulting in instant relief and the patient returning to full duty by the fifth morning [5].

Complications and Prognosis: Nail-bed injuries are often neglected and can result in a painful deformed nail that diminishes the function of the finger in pinch and other activities [29].

Key Evidence

See Also

References

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2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.