Simon Carley Do risk factors really factor? #SMACCGold Autoimmune disease, including psoriasis and lupus What is paronychia? 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. Newsletter DESCRIPTION Arthritis Rick Body. How free, open access medical education is changing Emergency Medicine. #RCEM15 Nystatin cream Paronychiae may be prevented by avoiding behaviors such as nail biting, finger sucking, and cuticle trimming. Patients with chronic paronychia should be advised to keep their nails short and to use gloves when exposed to known irritants. Actions Tonsillitis Treating RA With Biologics Keep affected areas clean and dry Editorial Policy Hide/Show Comments Questions to Ask Your Doctor #stemlynsLIVE References Paronychia at DermNet.NZ clipping a nail too short or trimming the cuticle (the skin around the sides and bottom of the nail) 18. Journeau P. Hand infections in children [in French]. Arch Pediatr. 2000;7(7):779–783. Onycholysis Causes and Treatments Put your email in the box below and we will send you lots of #FOAMed goodness 9. Lee TC. The office treatment of simple paronychias and ganglions. Med Times. 1981;109:49–51,54–5. Information from Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin 1998;14:547–55. Staying Healthy ^ Jump up to: a b c d Rockwell PG (March 2001). "Acute and chronic paronychia". Am Fam Physician. 63 (6): 1113–6. PMID 11277548. Prevention & Treatment Oncology Nurse Advisor I get ingrown toenails a lot. What can I do to prevent paronychia? MyChartNeed help? Print/export Depression EM Journal Clubs What treatment is best for me? ACUTE This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests. Often, you will be asked to return to the doctor’s office in 24-48 hours. This may be necessary to remove packing or change a dressing. It is very important that you have close follow-up care to monitor the progress or identify any further problems. Do You Have a Fungal or Yeast Infection? Check Out These 10 Types. pink, swollen nail folds (chronic) Media file 4: Drainage of pus from a paronychia. Image courtesy of Glen Vaughn, MD. 7. Wollina U. Acute paronychia: comparative treatment with topical antibiotic alone or in combination with corticosteroid. J Eur Acad Dermatol Venereol. 2001;15(1):82–84. Illnesses & Injuries Need help? Diet, Food & Fitness Manage Your Medications Daniel CR 3rd, Iorizzo, M, Piraccini, BM, Tosti, A. "Grading simple chronic paronychia and onycholysis". Int J Dermatol. vol. 45. 2006 Dec. pp. 1447-8. Avoid injuring your nails and fingertips. Visit our other Verywell sites: Sign Up Now Medical Knowledge In this section, specific hand infections will be considered:  Google Paronychia is an infection of the layer of skin surrounding the nail (known as the perionychium). It is the most common hand infection in the United States and is seen frequently in children as a result of nail biting and finger sucking. 5 References An infection of the cuticle secondary to a splinter Rheumatology Advisor Approach Case of the week The paronychium is a small band of epithelium that covers the medial and lateral borders of the nail. The eponychium is a small band of epithelium that covers the proximal aspect of the nail. More in AFP Healthy Food Choices Acute: The clinical picture may be very variable but in principle there is redness, with or without pus (around the nail plate or beneath the nail bed), and swelling around the nail plates (usually lateral and or proximal nail folds) (Figure 1). Acute paronychia causes warmth and variable pain along the nail margin; mild pressure on the nail folds may provoke severe pain. Subungual hematoma (smashed fingernail, blood under the nail) Felon: Often, incision and drainage is required because the infection develops within the multiple compartments of the fingertip pad. Usually an incision will be made on one or both sides of the fingertip. The doctor will then insert an instrument into the wound and break up the compartments to aid in the drainage. Sometimes, a piece of rubber tubing or gauze will be placed into the wound to aid the initial drainage. The wound may also be flushed out with a sterile solution to remove as much debris as possible. These infections will require antibiotics. The wound will then require specific home care as prescribed by your doctor. How to Make a Vinegar Foot Soak Preventing hangnails is one of the best ways to avoid infected hangnails. Chronic paronychia, by contrast, will typically be treated with a topical antifungal medication such as ketoconazole cream. A mild topical steroid may also be used in addition to the antifungal to help reduce inflammation. (Steroids, however, should never be used on their own as they are unable to treat the underlying fungal infection.) Jump up ^ Serratos BD, Rashid RM (200). "Nail disease in pemphigus vulgaris". Dermatol Online J. 15 (7): 2. PMID 19903430. Global Health Don't cut nails too short. Trim your fingernails and toenails with clippers or manicure scissors, and smooth the sharp corners with an emery board or nail file. The best time to do this is after a bath or shower, when your nails are softer. 6. Sebastin S, Chung KC, Ono S. Overview of hand infections. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-hand-infections?source=search_result&search=Felon&selectedTitle=1~4. Last updated February 8, 2016. Accessed February 28, 2017. Healthy Living Healthy Last reviewed: August 2018 you have diabetes and you suspect your hangnail is infected B Healthy Beauty Simon Carley Do risk factors really factor? #SMACCGold Dermatology Registrar Insurance Guide ^ Jump up to: a b c James, William D.; Berger, Timothy G. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 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). A hangnail isn’t the same condition as an infected or ingrown nail. A hangnail only refers to the skin along the sides of the nail, not the nail itself. Download as PDF Antibiotics (oral) Usually, depending on the severity and the pathogenic cause(s) of the acute paronychia, a systemic antibiotic should be given to the patient against S.aureus (sometimes Streptococcus pyogenes or Pseudomonas aeruginosa causing the greenish-black in color beneath the nail plate, is the cause of the acute paronychia). Among the different systemic antibiotics that could be used are Flucloxacillin, 250mg 4 times daily for up to 10 days or Clindamycin, 300mg twice daily for 7-10 days. Acute paronychia: The major causative organism is Staphylococcus aureus. Less common organisms are Streptococcus species, Pseudomonas or Proteus spp. 13 more 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. Further Reading/Other FOAM Resources Português Paronychia: The area next to the fingernail will appear red and swollen. A visible collection of pus may be seen under the skin and nail. This fluid may be actually leaking out of the wound. The area will be tender and painful to the touch. The drainage from the area is usually a cloudy white-yellow color. Use rubber gloves, preferably with inner cotton glove or cotton liners Hepatotoxicity and QT prolongation may occur Daniel CR 3rd, Daniel, MP, Daniel, J, Sullivan, S, Bell, FE. "Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen". Cutis. vol. 73. 2004 Jan. pp. 81-5. Other Mimics and (Weird) Differentials Ignoring an infected hangnail can make your condition worse. In rare situations, the infection may spread to other parts of your body if left untreated. Contact your doctor if you have pus around or under the nail or if the infection doesn’t get better within a week. Keep your nails trimmed and smooth. Candida albicans and/or Pseudomonas may be cultured. Treating the underlying dermatitis is very important: avoidance of further irritants together with emollient use is a good start. Topical steroids are first-line therapy but culture is really important here: steroids are usually given with topical antifungal but oral antifungal such as itraconazole or fluconazole may be indicated if C.albicans is isolated. The digital pressure test may be helpful in the early stages of paronychial infection when there is doubt about the presence or extent of an abscess. A favourite among SAQ-writers, flexor tenosynovitis is an acute (bacterial) infection within the finger’s flexor sheath which may arise following penetrating trauma to the tendon sheath or as spread from an untreated felon. There are four cardinal signs as described by Kanavel: SIMILAR ARTICLES Diagnosis[edit] What is nail infection (paronychia)? Staying Safe Water and irritant avoidance is the hallmark of treatment of chronic paronychia. Don’t rip off the hangnail, as it can worsen the condition. If your symptoms worsen or don’t clear within a week, consult your doctor. You should also consult your doctor if you’re experiencing severe pain, major swelling of the finger, excessive pus, or other signs of infection. Three times daily for five to 10 days Health A-Z Visit our interactive symptom checker Critical Care Horizons Subungual hematoma (smashed fingernail, blood under the nail) seborrheic dermatitis | paronychia finger seborrheic dermatitis | paronychia home treatment seborrheic dermatitis | swollen infected finger
Legal | Sitemap