101 personal & philosophical experiments in EM A MedlinePlus: 001444eMedicine: derm/798 Is it possible that a foreign body is in the wound? Life in the Fast Lane ED Management Probably not healthy patients, but this open access case report describes disseminated Fusarium infection in a patient with neutropenia from AML, thought to have arisen from a toenail paronychia. Treatment of chronic paronychia includes avoiding exposure to contact irritants and appropriate management of underlying inflammation or infection.12,20 A broad-spectrum topical antifungal agent can be used to treat the condition and prevent recurrence.22 Application of emollient lotions to lubricate the nascent cuticle and the hands is usually beneficial. One randomized controlled trial assigned 45 adults with chronic paronychia to treatment with a systemic antifungal agent (itraconazole [Sporanox] or terbinafine [Lamisil]) or a topical steroid cream (methylprednisolone aceponate [Advantan, not available in the United States]) for three weeks.21 After nine weeks, more patients in the topical steroid group were improved or cured (91 versus 49 percent; P < .01; number needed to treat = 2.4). Rich P. Overview of nail disorders. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-nail-disorders. Last updated August 29, 2017. Accessed February 24, 2018. SURGICAL TREATMENT Clinical recommendation Evidence rating References Procedural videos How the Body Works Check for Interactions Export to EPUB See the following for related finger injuries: Dermatology Consultant Development of red streaks along the skin Healthy Living 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 Chronic paronychia usually causes swollen, red, tender and boggy nail folds (Figure 4). Symptoms are classically present for six weeks or longer.11 Fluctuance is rare, and there is less erythema than is present in acute paronychia. Inflammation, pain and swelling may occur episodically, often after exposure to water or a moist environment. Eventually, the nail plates become thickened and discolored, with pronounced transverse ridges.6,8 The cuticles and nail folds may separate from the nail plate, forming a space for various microbes, especially Candida albicans, to invade.8 A wet mount with potassium hydroxide from a scraping may show hyphae, or a culture of the purulent discharge may show hyphae for bacteria and fungal elements. C. albicans may be cultured from 95 percent of cases of chronic paronychia.6 Other pathogens, including atypical mycobacteria, gram-negative rods and gram-negative cocci, have also been implicated in chronic paronychia (Table 1).6 If you have been prescribed antibiotics for a finger infection, you must follow the directions and take them for the prescribed time period. Fight bites should be meticulously irrigated, preferably with a formal debridement by a hand surgeon in the operating room. The laceration must not be closed in the ED. User Edits Comments Labels Label List Last Update Abstract If you have diabetes, make sure it is under control. #FOAMed Summary More ACUTE Epidemiology How to Spot and Treat Cellulitis Before It Becomes a Problem Once or twice daily until clinical resolution (one month maximum) Interaction Resources  Media type: Illustration Recurrent manicure or pedicure that destroyed or injured the nail folds felon, finger swelling, paronychia, whitlow What Causes Peeling Fingertips and How Is It Treated? Paronychia (synonymous with perionychia) is an inflammatory reaction involving the folds of tissue surrounding a fingernail or toenail. The condition is the result of infection and may be classified as acute or chronic. This article discusses the etiology, predisposing factors, clinical manifestation, diagnosis, and treatment of acute and chronic paronychia. Let’s start with some anatomy (hurrah!) Synonyms pronounce = /ˌpærəˈnɪkiə/ NEWS CASES CALCULATORS CHARTS CME DRUGS MEETINGS MULTIMEDIA RESOURCES Simon Carley #SMACC2013 Educational Leadership and Subversion 5. Fox J. Felon. In: Felon. New York, NY: WebMD. http://emedicine.medscape.com/article/782537-treatment#showall. Updated February 29, 2016. Accessed February 14, 2017. Article Drugs, Procedures & Devices 3. Causes EMManchester General Health Depression Address Drug Dependency Avoid contact with eyes and mucous membranes Nail injuries 31. Gorva AD, Mohil R, Srinivasan MS. Aggressive digital papillary adenocarcinoma presenting as a paronychia of the finger. J Hand Surg [Br]. 2005;30(5):534. 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. Overview Paronychia: acute and chronic (nail disease, felon/whitlow) swab for Gram stain, culture, and sensitivity (acute or acute-on-chronic) Scott Weingart (aka emcrit) Betamethasone valerate 0.1% solution or lotion (Beta-Val) MORE SECTIONS PROGNOSIS 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. the affected area doesn’t improve after a week of home treatment ^ 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. Synonyms pronounce = /ˌpærəˈnɪkiə/ The key to preventing disability and possible loss of the finger is early and appropriate treatment. If any signs and symptoms are present, you should contact your doctor at once. SMACCGold Workshop. I’ve got papers….what next? Find A Doctor Educational theories you must know: Constructivism and Socio-constructivism. The philosophy of EM Patient Rights Paronychia caused by bacteria can get worse quickly. Fungus-caused paronychia typically gets worse much more gradually. Diagnosis of an established joint infection is often made by clinical examination. Patients will have swelling and erythema centered on the affected joint.  Motion or axial loading of the joint will increase pain.  Assessment of joint fluid for cell count, gram stain, and crystals (acute crystalline arthropathy such as gout can mimic a joint infection) can aid in the diagnosis, but it is often quite difficult to pass a needle into the narrow joint space and obtain an adequate sample.  Serum markers of inflammation (such as white blood cell count, erythrocyte sedimentation rate, and C - reactive protein) are not typically elevated with an infection of a small joint of the hand.  Xrays should be obtained to ensure that there is no fracture or retained tooth fragment. Peyronie’s Disease -The nails and their surroundings should be dry (wetness and humidity to the proximal and lateral nail folds may cause damage to the cuticles leading to a “port of entry”) Powered By Decision Support in Medicine Diseases & Conditions seborrheic dermatitis | felon finger treatment seborrheic dermatitis | felon treatment seborrheic dermatitis | fingernail abscess
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