KEY TERMS 18. Journeau P. Hand infections in children [in French]. Arch Pediatr. 2000;7(7):779–783. What is nail infection (paronychia)? Partners Dashboard >Musculoskeletal Medicine for Medical Students >Hand and Wrist topics >Finger and hand infections Baby Approach Pathogen: Staphylococcus aureus (most common), Streptococcus pyogenes, Pseudomonas, gram-negative bacteria, anaerobic bacteria, Fusarium URL: https://www.youtube.com/watch%3Fv%3DASTC2NpPYk0 paronychia, hangnail, onychia lateralis, onychia periungualis, felon, whitlow, herpetic whitlow, cellulitis, infectious flexor tenosynovitis, pyogenic flexor tenosynovitis, flexor tendosynovitis, tendosynovitis, deep space infections, collar button abscess, finger injury, finger infection, onychomycosis An acute paronychia, like the one above, is typically of relatively short onset and evolves over a few days. It can occur in fingers or toes, on the radial or ulnar (medial or lateral in toes) side of the nail. The usual infective organism is Staph. aureus in adults (mouth flora in children); the affected digit is red, warm, painful and swollen, sometimes with reported or visualised pus (you can sometimes see a little dried crusty yellow collection at the nail fold). The infection commonly follows minor nail trauma, such as a manicure or, more commonly, nail biting or sucking. Symptom Checker Over-the-counter Products NEWS CASES CALCULATORS CHARTS CME DRUGS MEETINGS MULTIMEDIA RESOURCES 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. A compromised immune system, such as with people living with HIV Turkman et al described the "digital pressure test for paronychia": A paronychia will appear as a blanched area when light pressure is applied to the volar aspect of the affected digit. Home treatments are often very successful in treating mild cases. If you have a collection of pus under the skin, you can soak the infected area in warm water several times per day and dry it thoroughly afterward. The soaking will encourage the area to drain on its own. Herpetic whitlow: Antiviral drugs such as acyclovir (Zovirax) may shorten the duration of illness. Pain medication is often needed. The wound must be properly protected to prevent a secondary bacterial infection and to prevent you from infecting other sites on your body or other people. Incision and drainage is not proper and, if done, may actually delay healing. TOPICS Nail Abnormalities Breast Cancer Signs & Symptoms 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. Cellulitis: The doctor will need to consider other causes that may look similar such as gout, various rashes, insect sting, burns, or blood clot before the final diagnosis is made. An X-ray may be obtained to look for a foreign body or gas formation that would indicate a type of serious cellulitis. If paronychia doesn't get better after a week or so, call your doctor. You'll want to call a doctor right away if you have an abscess (a pus-filled area in the skin or under the nail) or if it looks like the infection has spread beyond the area of the nail. You should schedule an appointment with your doctor if: 6 External links frequent sucking on a finger People repeatedly exposed to water or irritants (e.g., bartenders, housekeepers, dishwashers) Insurance & Bills felon, finger swelling, paronychia, whitlow Once the pus is out, the pain will improve quite a bit (although not altogether to begin with). Because you aren’t cutting the skin (in my approach), ring block or local anaesthesia is usually unnecessary. You are simply “opening the eponychial cul-de-sac” to allow the pus to escape. You can consider inserting a wick (1cm of 1/4″ gauze) afterwards if you really want to, in order to facilitate ongoing drainage. As you express the last of the pus, you will sometimes get some blood mixed with it which is normal and to be expected considering the vascularity of the finger and the degree inflammation present before you start. Page History (An excellent summation of how the patient should manage their condition in addition to therapeutic advice for the physician on how to approach the infectious and inflammatory nature of the condition, using antifungals and corticosteroids, respectively.) Figure This patient’s fourth digit exhibits erythema, fusiform swelling, and mild flexion compared to the adjacent digits. 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. ISSN 2515-9615 Recurrent manicure or pedicure that destroyed or injured the nail folds Symptoms ACNE Surely that’s not an Emergency Department problem?! Editorial Board St.Emlyn’s Actions If caught early and without fluctuance: elevation and warm soaks 3–4 times daily Use rubber gloves, preferably with inner cotton glove or cotton liners Submissions Child Nutritional Needs the initial examiner may underestimate the severity of the wound, as it is usually small (the size of an incisor tooth or smaller, eg 3mm) with clean edges If you have been prescribed antibiotics for a finger infection, you must follow the directions and take them for the prescribed time period. A felon is an abscess on the palmar surface of the fingertip. Bacteria are normally introduced via minimal penetrating trauma, such as a splinter. Gram stain/culture to identify pathogen 100 mg orally once daily for seven to 14 days Figure: a punch to the tooth may inadvertently lacerate the skin over the MCP joint and introduce oral flora into the joint   FEEDBACK Medicolegal Yes, really. In flexor tenosynovitis, the infection is within the flexor tendon sheath. This infection is particularly harmful because bacterial exotoxins can destroy the paratenon (fatty tissue within the tendon sheath) and in turn damage the gliding surface of the tendon. In addition, inflammation can lead to adhesions and scarring, and infection can lead to overt necrosis of the tendon or the sheath. missing cuticle (chronic) Show More Need help? 1st investigations to order Your Health Resources An updated article on paronychia is available. Email What is paronychia? Paronychia is an infection of the skin at the nail fold (the paronychium). Other terms are often used interchangeably but incorrectly: a felon is a pulp infection (abscess) occurring on the palmar (non-nail) side of the phalanx; a whitlow is usually an herpetic infection of the soft tissues of the distal phalanx (more on that later too). Medicolegal Cocoa butter is a staple in skin creams and other health and beauty products, but do its benefits really add up? Find out what researchers have to say. 7 Ways You're Wrecking Your Liver Paronychia is an infection of the skin around your fingernails and toenails. Bacteria or a type of yeast called Candida typically cause this infection. Bacteria and yeast can even combine in one infection. redness Pain over the flexor tendon sheath with passive extension of the finger Treatment involves surgical drainage and antibiotics. Incision and drainage is performed at the most fluctuant point. The incision should not cross the distal interphalangeal joint flexion crease (to prevent formation of a flexion contracture from scar formation) or penetrate too deeply (to prevent spread of infection from violating the flexor tendon sheath). Potential complications of excessive dissection to drain a felon include an anesthetic fingertip or unstable finger pad. Staphylococcal aureus, streptococci, Pseudomonas, anaerobes Aging Well How to Handle High-Tech Hand Injuries More Topics Most common hand infection in the United States MORE SECTIONS Living Well What is the Cause of the Disease? It’s odd how we seem to find ourselves with very niche interest areas in Emergency Medicine. Paronychia is one of mine, for a variety of reasons – probably firstly because I used to be a nail-biter and so had a lot of paronychia growing up, secondly because I had some great teaching from some Nurse Practitioners on the topic early in my ED career and thirdly because I made a Borat-themed Paronychia quiz for registrar teaching when I was a trainee that I remain unjustifiably proud of. Morale Health News Expert Blogs and Interviews "Paronychia Nail Infection". Dermatologic Disease Database. American Osteopathic College of Dermatology. Retrieved 2006-07-12. Dry hands are common in the cold winter months. Learn 10 tips for keeping your skin hydrated, and learn more about other causes of that dry skin. motion of the MCP joint to "shake off the pain" may drive saliva deeper into the tissue Combination antifungal agent and corticosteroid occupational risks (acute and chronic) Date reviewed: January 2015 ← Previous post Felon: A history of a puncture wound or cut will aid the diagnosis. This would include a plant thorn. The doctor may obtain an x-ray to look for involvement of the bone or possible foreign body. -Avoidance of exposure of the nail plates and /or the lateral and proximal nail folds to different detergents and /or other irritants by using plastic gloves with gentle cotton lining. This article was contributed by: familydoctor.org editorial staff Control Allergies ACUTE Contact READ THIS NEXT Slideshow What Are the Best Treatments for Tinea Versicolor? Access Keys: Don't bite your nails or pick at the cuticle area around them. Avoid nail trauma, biting, picking, and manipulation, and finger sucking Health A-Z Ways to Prevent Paronychia Expert Blogs and Interviews Insurance Guide Recent changes Hand-Foot-and-Mouth Disease DIFFERENTIAL DIAGNOSIS Eye Health Name Privacy Policy If the infections are treated early and properly, the prognosis for full recovery is good. However, if treatment is delayed, or if the infection is severe, the prognosis is not as good. What kind of paronychia do I have? Paeds Fitness & Exercise Diseases & Conditions References:[5][6] What happens if an infected hangnail isn’t treated? Figure The bevel of an 18 gauge needle is passed between the nail plate below and the nail fold above to allow for drainage of the pus. × Sex and Sexuality Forums Staphylococcus aureus and Streptococcus pyogenes bacteria are the most common culprits in acute paronychia but there are other causes as well. Attachments Ambulatory Care By Chris Craig (Ciotog) [Public domain], from Wikimedia Commons Disorders of skin appendages (L60–L75, 703–706) Blistering distal dactylitis tinea versicolor | infection under fingernail tinea versicolor | infection under nail tinea versicolor | paronychia causes
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