Chronic paronychia is a chronic irritant dermatitis of the periungual tissues resulting from barrier damage to the protective nail tissues, including the cuticle and the proximal and lateral nail folds. If what you’re seeing is particularly crusty, consider whether there might be a herpetic infection instead of bacterial. Herpetic whitlow is common secondary to Herpes simplex (exogenous or autogenous) and may be seen in children, teenagers, sex workers, healthcare workers and historically in dentists (though I suspect most area invested in wearing gloves nowadays, reducing their exposure) – basically anyone who has exposure to perioral Herpes simplex at their fingertips (toes are a bit less common… for most people). You might see multiple vesicles and visible signs may be preceded by reported symptoms of itching, burning or tingling in the affected digit. Early oral aciclovir is the usual suggested therapy. Meetings Calendar Systemic Diseases Finger and hand infections Questions Figure: a punch to the tooth may inadvertently lacerate the skin over the MCP joint and introduce oral flora into the joint  RxList 1. Overview Puberty & Growing Up Compassion RESOURCES 1. Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol. 2014; 59(1): pp. 15–20. doi: 10.4103/0019-5154.123482. Paronychia is one of the most common infections of the hand. Paronychias are localized, superficial infections or abscesses of the perionychium (epidermis bordering the nails). Paronychial infections develop when a disruption occurs between the seal of the proximal nail fold and the nail plate that allows a portal of entry for invading organisms. ^ Jump up to: a b c Freedberg, Irwin M., ed. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill Publishing Company. ISBN 0071380760. Flu-like symptoms Bonifaz A, Paredes V, Fierro L. Paronychia. Skinmed. 2013 Jan-Feb;11(1):14-6. major incident The correct diagnosis will start with a detailed history and physical exam. People who have a localized infection will be treated differently than someone with a severe infection. Coexisting problems such as diabetes or blood vessel disorders of the arms and legs will complicate the infection and may change the degree of treatment.  Since the different causes of (acute and chronic) paronychia are variable, the patient’s history regarding the paronychia is extremely important. Reviewed by: Sonali Mukherjee, MD Consider antifungal: topical (e.g., miconazole); oral (e.g., fluconazole) if severe If the diagnosis of flexor tenosynovitis is not clear, the patient may be admitted to the hospital for antibiotics, elevation of the affected hand, and serial examination. Non-operative treatment should be reserved for normal hosts. In patients with diabetes or any disease that may compromise the immune system, early surgical drainage is indicated even for suspected cases. 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. 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. Important information that your doctor will need to know will include the following: Lifewire Depression in Children and Teens Nystatin cream Privacy policyAbout WikipediaDisclaimersContact WikipediaDevelopersCookie statementMobile view Antifungal agents (oral) Stop Infestations About CME/CPD Topics Pregnancy Family & Pregnancy If you have a pus-filled abscess pocket, your doctor may need to drain it. Your doctor will numb the area, separate the skin from the base or sides of the nail, and drain the pus. #FOAMed, Emergency Medicine, Featured, Minor Injuries, musculoskeletal Synonyms pronounce = /ˌpærəˈnɪkiə/ MedicineNet An updated article on paronychia is available. The optimal treatment is different for acute verus chronic paronychia. For acute paronychia, optimal treatment is systemic/topical treatment or surgery. For chronic paronychia, optimal treatment is prevention and treatment of the chronic inflammation. -Not biting or picking the nails and /or the skin located around the nail plates (proximal and lateral nail folds) Immunization Schedules View More None Get your personalized plan. Follow up  Nutrient Shortfall Questionnaire Travel toxicology Want to use this article elsewhere? Get Permissions Will I need surgery? 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. How can I avoid getting paronychia? 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. EM Zen. Thinking about Thinking. Other diseases, such as diabetes mellitus, skin cancer Ross Fisher Videos Prosector’s Paronychia Caitlin McAuliffe 0 1 0 less than a minute ago Prosector’s Paronychia Log In Kids site 4. Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. 1999;17(6):581–582. pus under fingernail | pus in nail pus under fingernail | soak infected finger pus under fingernail | swelling around fingernail
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