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. Breathe Better at Home TOPICS Post-operative adhesions damage gliding surfaces and decrease active range of motion, and thus require tenolysis. Soft tissue necrosis and flexor tendon rupture are other relatively common complications. 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. 3.1 Types The diagnosis of acute paronychia is based on a history of minor trauma and findings on physical examination of nail folds. The digital pressure test may be helpful in the early stages of infection when there is doubt about the presence or extent of an abscess.14 The test is performed by having the patient oppose the thumb and affected finger, thereby applying light pressure to the distal volar aspect of the affected digit. The increase in pressure within the nail fold (particularly in the abscess cavity) causes blanching of the overlying skin and clear demarcation of the abscess. In patients with severe infection or abscess, a specimen should be obtained to identify the responsible pathogen and to rule out methicillin-resistant S. aureus (MRSA) infection.13 Powered By Decision Support in Medicine 10. Jules KT, Bonar PL. Nail infections. Clin Podiatr Med Surg. 1989;6:403–16. Since the different causes of (acute and chronic) paronychia are variable, the patient’s history regarding the paronychia is extremely important. Hangnails are common, especially if your hands are dry because of the weather or from frequent exposure to water. Most hangnails will heal on their own without any signs of infection. Family & Pregnancy Paeds Medical Technology Overgrowth of nonsusceptible organisms with prolonged use Health & Balance Can a Warm Soak With Epsom Salt Really Help Your Skin? Clinical features 7. Prevention Advertising Policy Featured Medical Knowledge Taking Meds When Pregnant 3. Causes Acute paronychia. ADD/ADHD Acute paronychia most commonly results from nail biting, finger sucking, aggressive manicuring, a hang nail or penetrating trauma, with or without retained foreign body3(Figure 2). Sculptured fingernail (artificial nail) placement has also been shown to be associated with the development of paronychia.4 The most common infecting organism is Staphylococcus aureus, followed by streptococci and pseudomonas organisms. Gram-negative organisms, herpes simplex virus, dermatophytes and yeasts have also been reported as causative agents. Children are prone to acute paronychia through direct inoculation of fingers with flora from the mouth secondary to finger sucking and nail biting. This scenario is similar to the acquisition of infectious organisms following human bites or clenched-fist injuries.5 Nail Anatomy 101: How They're Made and How They Grow Acrokeratosis Paraneoplastica Advertise Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. Psoriasis and Reiter syndrome may also involve the proximal nail fold and can mimic acute paronychia.10 Recurrent acute paronychia should raise suspicion for herpetic whitlow, which typically occurs in health care professionals as a result of topical inoculation.12 This condition may also affect apparently healthy children after a primary oral herpes infection. Herpetic whitlow appears as single or grouped blisters with a honeycomb appearance close to the nail.8 Diagnosis can be confirmed by Tzanck testing or viral culture. Incision and drainage is contraindicated in patients with herpetic whitlow. Suppressive therapy with a seven-to 10-day course of acyclovir 5% ointment or cream (Zovirax) or an oral antiviral agent such as acyclovir, famciclovir (Famvir), or valacyclovir (Valtrex) has been proposed, but evidence from clinical trials is lacking.15 14 tips to ditch the itch. Early oral antibiotic treatment, decompression , and elevation should improve the condition in 12–24 hours. for Parents Injury to the nail folds mechanically or by sucking the fingernails Resources for the FCEM exam Navigation menu Cookie policy St.Emlyn’s at #EuSEM18 – Day 3 Chronic Paronychia 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. Bonifaz A, Paredes V, Fierro L. Paronychia. Skinmed. 2013 Jan-Feb;11(1):14-6. Tags Ensure that your manicurist always uses sterile instruments. Rub vitamin E oil or cream on the affected area to prevent another hangnail. Acne Eczema & Dermatitis Fitness & Exercise Next article >> Conservative treatment, such as warm-water soaks three to four times a day, may be effective early in the course if an abscess has not formed.3 If infection persists, warm soaks in addition to an oral antistaphylococcal agent and splint protection of the affected part are indicated. Children who suck their fingers and patients who bite their nails should be treated against anaerobes with antibiotic therapy. Penicillin and ampicillin are the most effective agents against oral bacteria. However, S. aureus and Bacteroides can be resistant to these antibiotics. Clindamycin (Cleocin) and the combination of amoxicillin–clavulanate potassium (Augmentin) are effective against most pathogens isolated from these infections.5,7 First-generation cephalosporins are not as effective because of resistance of some anaerobic bacteria and Escherichia coli.5 Some authorities recommend that aerobic and anaerobic cultures be obtained from serious paronychial infections before antimicrobial therapy is initiated.5 Help Peer Review this article. Use the form below to obtain credit and be included as a Peer Review Contributor. Journal Club Português  Cite this page redness of the skin around your nail 24. Ogunlusi JD, Oginni LM, Ogunlusi OO. DAREJD simple technique of draining acute paronychia. Tech Hand Up Extrem Surg. 2005;9(2):120–121. Diagnosis — retronychia Women Export to PDF Systemic implications and complications are rare but may include : 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 myCME Acute paronychia is an infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting less than six weeks.[2] The infection generally starts in the paronychium at the side of the nail, with local redness, swelling, and pain.[9]:660 Acute paronychia is usually caused by direct or indirect trauma to the cuticle or nail fold, and may be from relatively minor events, such as dishwashing, an injury from a splinter or thorn, nail biting, biting or picking at a hangnail, finger sucking, an ingrown nail, or manicure procedures.[10]:339 Abscess formation 23. Shaw J, Body R. Best evidence topic report. Incision and drainage preferable to oral antibiotics in acute paronychial nail infection?. Emerg Med J. 2005;22(11):813–814. Dashboard >Musculoskeletal Medicine for Medical Students >Hand and Wrist topics >Finger and hand infections Warm soaks, oral antibiotics (clindamycin [Cleocin] or amoxicillin–clavulanate potassium [Augmentin]); spontaneous drainage, if possible; surgical incision and drainage paronychia | how to treat an infected finger paronychia | pus in finger paronychia | finger without nail
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