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Using narrative learning and story telling in Emergency Medicine. St Emlyn’s Advertise Treatment Options note: Recommendations are based on expert opinion rather than clinical evidence.
STAMATIS GREGORIOU, MD, is a dermatologist-venereologist at the University of Athens Medical School and at the nail unit and hyperhidrosis clinic at Andreas Sygros Hospital. He received his medical degree from the University of Athens Medical School and completed a dermatology and venereology residency at Andreas Sygros Hospital.
In other projects Clinical Charts CANs – Critical Appraisal Nuggets from St.Emlyn’s The decision as to when to use topical and/or systemic treatment is based on to the severity and the cause of the paronychia, whether acute or chronic. Basically, the first step of the treatment of acute paronychia is based on the presence or absence of pus (abscess formation) in the proximal and/or lateral nail folds, just beneath the skin. In such cases the pus should be drained by skin incision. In deeper cases surgery should be performed. If the pus is located beneath the nail plate, the nail plate may be removed).
Media file 5: A paronychia can progress to a felon if left untreated. Image courtesy of A paronychia can progress to a felon if left untreated. Image courtesy of Glen Vaughn, MD.
Treatment consists of incision and drainage of the joint space.  For the metacarpophalangeal joints of the fingers, the approach is normally dorsal through the long extensor tendon.  In “fight bite” situations, there may be an indentation of the head of the metacarpal where it struck the tooth.   For the interphalangeal joint, the approach is normally dorsolateral between the extensor mechanism dorsally and the collateral ligament laterally.  Arthroscopic approaches have been described for the wrist and even the metacarpophalangeal joint, but an open approach is more commonly used.
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Nutrients and Nutritional Info Keep nails short Two or three times daily until the cuticle has regrown
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School & Family Life NEWS CASES CALCULATORS CHARTS CME DRUGS MEETINGS MULTIMEDIA RESOURCES Journal Club Most of the time, paronychia is no big deal and can be treated at home. In rare cases, the infection can spread to the rest of the finger or toe. When that happens, it can lead to bigger problems that may need a doctor’s help.
If infection develops and is not responsive to antibiotic treatment, discontinue use until infection is controlled What kind of paronychia do I have?
Some of these might surprise you. Medical Technology ETIOLOGY AND PREDISPOSING FACTORS
Acute paronychia. Current events Left and right ring fingers of the same individual. The distal phalanx of the finger on the right exhibits swelling due to acute paronychia.
Visit our interactive symptom checker Paronychia means inflammation of the nail apparatus. Acute paronychias are infections of the periungual tissues, usually presenting with an acutely painful, purulent infection. [Figure caption and citation for the preceding image starts]: Acute paronychia From the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends]. Chronic paronychia represents barrier damage to the protective nail tissues, including the cuticle and the proximal and lateral nail folds. [Figure caption and citation for the preceding image starts]: Chronic paronychia From the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends]. [Figure caption and citation for the preceding image starts]: Chronic paronychia From the collection of Dr N.J. Jellinek and Professor C.R. Daniel III [Citation ends]. The altered nail barrier predisposes the nail to irritant dermatitis, most importantly from water, soap, chemicals, and microbes. Avoidance of such irritants is the hallmark of treatment.
101 personal & philosophical experiments in EM A Famous Quote You have a fever or chills. Preventive measures for chronic paronychia are described in Table 2.3,10,13,19,20 Jump up ^ Paronychia~clinical at eMedicine
News Archive Chronic paronychia can occur on your fingers or toes, and it comes on slowly. It lasts for several weeks and often comes back. It’s typically caused by more than one infecting agent, often Candida yeast and bacteria. It’s more common in people who’re constantly working in water. Chronically wet skin and excessive soaking disrupts the natural barrier of the cuticle. This allows yeast and bacteria to grow and get underneath the skin to create an infection.
Psoriasis Cardiology Heart Disease 4. Rockwell PG. Acute and Chronic Paronychia. Am Fam Physician. 2001; 63(6): pp. 1113–1117. url:
Emergency Medicine #FOAMed Feelings Not logged inTalkContributionsCreate accountLog inArticleTalk having hands in water a lot (as from a job washing dishes in a restaurant)
Treating Advanced Prostate Cancer Risk factors include repeatedly washing hands and trauma to the cuticle such as may occur from biting. In the context of bartending, it is known as bar rot.[4]
Choose a language Drugs & Supplements Am Fam Physician. 2001 Mar 15;63(6):1113-1117.
Flexor tenosynovitis can also  have noninfectious causes such as chronic inflammation from diabetes mellitus, rheumatoid arthritis or other rheumatic conditions (eg, psoriatic arthritis, systemic lupus erythematosus, and sarcoidosis).
As in the treatment of any abscess, drainage is necessary. It should be performed under digital block anesthesia unless the skin overlying the abscess becomes yellow or white, indicating that the nerves have become infarcted, making the use of a local anesthetic unnecessary.9 The nail fold containing pus should be incised with a no. 11 or no. 15 scalpel with the blade directed away from the nail bed to avoid injury and subsequent growth abnormality6(Figure 3). After the pus is expressed, the abscess should be irrigated and packed with a small piece of plain gauze. An oral antibiotic agent should be prescribed. The dressing should be removed in 48 hours, followed by the initiation of warm soaks four times a day for 15 minutes.
Treatment of acute paronychia includes incision and drainage of any purulent fluid, soaks, and topical and/or oral antibacterials.
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There was an error. Please try again. Iain Beardsell. Pain and Suffering in the ED. #SMACCGold Definition: soft tissue infection around a fingernail Newsletter This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 12/28/2017
4 Treatment Opinion The best away to avoid acute paronychia is to take good care of your nails.
Caveats and Caution Disorders of skin appendages (L60–L75, 703–706) Info How to identify an infected hangnail See additional information.
4. Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. 1999;17(6):581–582. Dermatology Advisor LinkedIn
Next: Diagnosis and Tests Common Conditions Mallet finger (jammed finger, painful tendon injury, common sports injury)
Strep Throat Blog, News & Mobile Apps Family & Pregnancy Other Paronychia ALEVIZOS ALEVIZOS, MD, is a family physician at the Health Center of Vyronas in Athens, Greece. He received his medical degree from the University of Athens Medical School and completed a family medicine residency at Tzaneion General Hospital in Piraeus, Greece.
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PRINT Next article >> Sugar and Sugar Substitutes Different chemotherapies that may lead to paronychia People with the following conditions tend to have more extensive paronychial infections and may need to be treated with a prolonged course of antibiotics:
Skin Infection Around Fingernails and Toenails female Surgical Infections
Tenderness to palpation over the flexor tendon sheath. Expert Blog Dangers After Childbirth — What to Watch For In some cases, pus in one of the lateral folds of the nail
Next post → The Authorsshow all author info People with the following conditions tend to have more extensive paronychial infections and may need to be treated with a prolonged course of antibiotics:
Drug Basics & Safety Nystatin cream MS and Depression: How Are They Linked? Yes, really. Although patients may not recall a specific history of trauma, flexor tenosynovitis is usually the product of penetrating trauma. Flexor tenosynovitis may be caused by inoculation and introduction of native skin flora (eg, Staphylococcus and Streptococcus) or by more unusual organisms (eg, Pasteurella and Eikenella) when there is a bite wound.
In patients with a chronic paronychia that is unresponsive to therapy, unusual and potentially serious causes of abnormal nail and skin appearance, such as malignancy, should be explored.3,10
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14 tips to ditch the itch. Psoriasis Not to be confused with whitlow. Arthritis and Carpal Tunnel Syndrome
Simon Carley. What to Believe: When to Change. #SMACCGold Trusted medical advice from the Deep space infection: This is an infection of one or several deep structures of the hand or fingers, including the tendons, blood vessels, and muscles. Infection may involve one or more of these structures. A collar button abscess is such an infection when it is located in the web space of the fingers.
RISK FACTORS AND PREVENTION: Intense pain is experiences on attempts to extend the finger along the course of the tendon pus-filled blisters
Resources Classic signs of inflammation Nail Abnormalities More Young People Getting Shingles Sex and Birth Control How paronychia can be prevented Be alert for repeated excessive hand washing with water and certain soaps, detergents, and other chemicals, recurrent manicure or pedicure that destroyed or injured the nail folds, allergic contact dermatitis, or primary irritation due to certain nail polish or latex or excessive repeated habitual wet products.
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