PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan Onychomycosis (fungal infection of the fingernail or toenail) 4. Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. 1999;17:581–2. Diseases & Conditions 10. Jules KT, Bonar PL. Nail infections. Clin Podiatr Med Surg. 1989;6:403–16. Are You Confident of the Diagnosis? What is – and What isn’t – a Paronychia? Find Lowest Drug Prices Pagination Systemic implications and complications are rare but may include : Dermatology Advisor Twitter Family & Your use of this website constitutes acceptance of Haymarket Media's Privacy Policy and Terms & Conditions. Chronic paronychia can result as a complication of acute paronychia20 in patients who do not receive appropriate treatment.7 Chronic paronychia often occurs in persons with diabetes.3 The use of systemic drugs, such as retinoids and protease inhibitors (e.g., indinavir [Crixivan], lamivudine [Epivir]), may cause chronic paronychia. Indinavir is the most common cause of chronic or recurrent paronychia of the toes or fingers in persons infected with human immunodeficiency virus. The mechanism of indinavir-induced retinoid-like effects is unclear.25,26 Paronychia has also been reported in patients taking cetuximab (Erbitux), an anti-epidermal growth factor receptor (EGFR) antibody used in the treatment of solid tumors.27,28 A felon is an abscess on the palmar surface of the fingertip. Bacteria are normally introduced via minimal penetrating trauma, such as a splinter. Correction Policy 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 Ross Fisher Videos DESCRIPTION St.Emlyn's > Administration > Featured > Pointing the Finger – Paronychia in the Emergency Department Weight Loss & Obesity Educational theories you must know. Deliberate practice. St.Emlyn’s 19. Baran R. Common-sense advice for the treatment of selected nail disorders. J Eur Acad Dermatol Venereol. 2001;15(2):97–102. Public Health Use of this content is subject to our disclaimer Avoid trimming cuticles or using cuticle removers Other Mimics and (Weird) Differentials Scott Weingart (aka emcrit) When to see your doctor Cancer Therapy Advisor chemotherapeutic agents Any previous injuries to the area? Paronychia can occur with diabetes, drug-induced immunosuppression,[6] or systemic diseases such as pemphigus.[7] Community portal Skin Conditions The finger or hand may be placed in a splint. This provides both immobilization and protection. It will be important to follow the instructions regarding the care of the splint. You will need to protect and properly care for the splint. You should closely monitor the finger or hand to watch for complications such as swelling or infection under the splint. Educational theories you must know. Miller’s pyramid. St.Emlyn’s Adaptavist Theme Builder Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet. Any disruption of the seal between the proximal nail fold and the nail plate can cause acute infections of the eponychial space by providing a portal of entry for bacteria. Treatment options for acute paronychias include warm-water soaks, oral antibiotic therapy and surgical drainage. In cases of chronic paronychia, it is important that the patient avoid possible irritants. Treatment options include the use of topical antifungal agents and steroids, and surgical intervention. Patients with chronic paronychias that are unresponsive to therapy should be checked for unusual causes, such as malignancy. Injury Rehabilitation Medical Reference WebMD Network Choose a language Clinical recommendation Evidence rating References Avoid contact with eyes; may irritate mucous membranes; resistance may result with prolonged use MPR Date reviewed: January 2015 Contents The palmar aspect of the fingertip contains many osteocutaneous ligaments that connect the palmar skin of the fingertip to the distal phalanx. These ligaments prevent excessive mobility of the skin during pinch; they also maintain position of the cutaneous sensory endings and receptors to allow for identification of objects during grasp. The organization of these osteocutaneous ligaments form a relatively non-compliant compartment in the distal phalanx; thus, rather than expanding when pus is introduced, the compartment will simply increase in pressure. Don't bite your nails or pick at the cuticle area around them. Peeling Nails Herpetic whitlow: A herpetic whitlow is an infection of the fingertip area caused by a virus. This is the most common viral infection of the hand. This infection is often misdiagnosed as a paronychia or felon. Dermatology Registrar When no pus is present, warm soaks for acute paronychia is reasonable, even though there is a lack of evidence to support its use.[12] Antibiotics such as clindamycin or cephalexin are also often used, the first being more effective in areas where MRSA is common.[12] If there are signs of an abscess (the presence of pus) drainage is recommended.[12] 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. Clinical features Biting, chewing or picking at nails, pulling hangnails or sucking on fingers can increase the risk of getting an infection. An ingrown toenail can also cause paronychia. NEWS CASES CALCULATORS CHARTS CME DRUGS MEETINGS MULTIMEDIA RESOURCES Random article Causes of Tingling in Hands and Feet 3. Causes Arthropod bite or sting Fusiform (sausage-shaped, or tapering) swelling. What links here Body Adaptavist Theme Builder Treatment Options Nail Structure and Function Media type: Illustration Updated April 24, 2018 By Chris Craig (Ciotog) [Public domain], from Wikimedia Commons Clinical features Slideshow Supplements for Better Digestion Rosacea How paronychia can be prevented Often, your doctor will instruct you to keep your hand elevated to prevent swelling. This is important and needs to be done both during the day and night. By placing pillows next to you while sleeping, your hand can remain elevated. Related Content Simon Carley Wrestling with risk #SMACC2013 Differentials Illnesses & Injuries Community portal Tips to Better Manage Your Migraine Paronychia (pronounced: pair-uh-NIK-ee-uh) is an infection of the skin around a fingernail or toenail. The infected area can get swollen, red, and painful. Sometimes a pus-filled blister may form. MPR First Aid Commonly Used Medications for Acute and Chronic Paronychia Vaccines Patient leaflets Phillips BZ. Nail Anatomy. In: Nail Anatomy. New York, NY: WebMD. http://emedicine.medscape.com/article/1948841-overview. Updated September 12, 2013. Accessed February 28, 2017. tinea versicolor | swollen nail bed tinea versicolor | bacterial toe infection tinea versicolor | finger infection near nail
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