Paronychia is an inflammation of the folds of tissue surrounding the nail of a toe or finger. Paronychia may be classified as either acute or chronic. The main factor associated with the development of acute paronychia is direct or indirect trauma to the cuticle or nail fold. This enables pathogens to inoculate the nail, resulting in infection. Treatment options for acute paronychia include warm compresses; topical antibiotics, with or without corticosteroids; oral antibiotics; or surgical incision and drainage for more severe cases. Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. The patient should avoid exposure to contact irritants; treatment of underlying inflammation and infection is recommended, using a combination of a broad-spectrum topical antifungal agent and a corticosteroid. Application of emollient lotions may be beneficial. Topical steroid creams are more effective than systemic antifungals in the treatment of chronic paronychia. In recalcitrant chronic paronychia, en bloc excision of the proximal nail fold is an option. Alternatively, an eponychial marsupialization, with or without nail removal, may be performed. Subungual hematoma (smashed fingernail, blood under the nail) Appointments 216.444.5725 If you have diabetes, make sure it is under control. Ravi Ubriani, MD, FAAD Early recognition and proper treatment of the following main finger infections will help prevent most of the serious outcomes. Common Conditions ED Management Famous Quote Liz Crowe Videos More in Skin Health Cracked Heels and Dry Skin on Feet: Know the Facts Finger infections Nail Anatomy Page History PROGNOSIS First Aid Permanent link 100 mg orally once daily for seven to 14 days Rehabilitation Services Emerging SKILLS 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. Do I need to take an antibiotic? Figure Proximal and distal incisions have been made, allowing adequate drainage of the flexor tendon sheath. Dislocated finger Recipes Do I have paronychia? Condition Next post → Dosage adjustment recommended in patients with renal impairment Chances are, if you have paronychia, it will be easy to recognize. There will be an area of skin around a nail that is painful and tender when you touch it. The area probably will be red and swollen and feel warm. You may see a pus-filled blister. Resources for the FCEM exam Quizzes Table 1 Current events Categories: Men, Seniors, Women 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: Permissions Guidelines 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. Causes of Erectile Dysfunction Signs and symptoms[edit] Healthline and our partners may receive a portion of revenues if you make a purchase using a link above. Clinical Guidelines Slideshows 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 About CME/CPD CLINICAL EVIDENCE Health Library Español "Paronychia Nail Infection". Dermatologic Disease Database. American Osteopathic College of Dermatology. Retrieved 2006-07-12. 160 mg/800 mg orally twice daily for seven days DESCRIPTION Women's Health Summary Noninfectious causes of paronychia include contact irritants and excessive moisture. Clinically, paronychia presents as an acute or chronic (longer than six weeks' duration) condition. People with occupations such as baker, bartender and dishwasher seem predisposed to developing chronic paronychia. Treatment may consist of warm-water soaks, antimicrobial therapy or surgical intervention. Clotrimazole cream (Lotrimin) The metacarpophalangeal and interphalangeal joints are closed, relatively avascular spaces. Infection can reach the joint space via direct penetration or hematogenous spread. Parents site Verywell is part of the Dotdash publishing family: Small (and ring) finger metacarpophalangeal joint infections in particular may result from a “fight bite,”  where the patient strikes and an opponent in the mouth with a closed fist and the opponent’s tooth penetrates the joint and seeds it with oral flora. As with flexor tenosynovitis, a major risk of joint space infection is destruction of the gliding surface by bacterial exotoxins, which can compromise recovery of motion after the infection resolves. 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. It may be that surgical intervention is needed, and/or that another systemic and/or topical treatment should be given. It should be stressed that in cases of abscess formation (beneath or around the nail) surgical involvement can give some relief but sometimes the pain from the surgical involvement itself can cause a painful sensation for several days. This should not be confused with worsening of the paronychia itself. Three or four times daily until clinical resolution (one month maximum) Featured Topics 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 Information from Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin 1998;14:547–55. Chronic paronychia can occur when nails are exposed to water or harsh chemicals for long periods of time. Moisture allows certain germs, such as candida (a type of fungus), and bacteria to grow. People whose hands may be wet for long periods of time are at higher risk for chronic paronychia. These may include bartenders, dishwashers, food handlers or housecleaners. Chronic paronychia may be caused by irritant dermatitis, a condition that makes skin red and itchy. Once the skin is irritated, germs can take hold and cause an infection. Disclosures the extensor tendon and joint capsule are fairly avascular and thus unable to fight infection Major Incidents Social Media Heartburn/GERD First rule of Journal Club You can avoid chronic paronychia by keeping your hands dry and free from chemicals. Wear gloves when working with water or harsh chemicals. Change socks at least every day, and do not wear the same shoes for two days in a row to allow them to dry out completely. Prolonged therapy over large body surface areas may suppress adrenal function; if infection develops, discontinue use until infection is controlled Arthropod bite or sting Ambulatory Care simulation According to Flickr, where I found this image, text before the picture reads: Hand Conditions Topics Pointing the Finger – Paronychia in the Emergency Department Chronic paronychia is an infection of the folds of tissue surrounding the nail of a finger or, less commonly, a toe, lasting more than six weeks.[2] It is a nail disease prevalent in individuals whose hands or feet are subject to moist local environments, and is often due to contact dermatitis.[9]:660 In chronic paronychia, the cuticle separates from the nail plate, leaving the region between the proximal nail fold and the nail plate vulnerable to infection.[11]:343 It can be the result of dish washing, finger sucking, aggressively trimming the cuticles, or frequent contact with chemicals (mild alkalis, acids, etc.). A hangnail is a piece of skin near the root of the nail that appears jagged and torn. Hangnails generally appear on the fingers and not on the toes, though it’s possible to have one around a toenail. The Balance Related Content FIGURE 3 UK DERMATOLOGY ADVISOR GOOGLE PLUS You might be right. All of my childhood paronychia were managed by my (non-medical) Mum, using hot water and encouragement to stop biting my nails (more on that later). But these patients do come to the Emergency Department, or minor injuries unit, so we should probably have some idea what to do with them. Chronic Paronychia Joint infection Treatment of chronic paronychia primarily involves avoiding predisposing factors such as exposure to irritating substances, prolonged exposure to water, manicures, nail trauma and finger sucking. When it is necessary to wear vinyl gloves, cotton gloves should be worn underneath.3,10 Treatment with a combination of topical steroids and an antifungal agent has been shown to be successful.3,7 Oral antifungal therapy is rarely necesssary.3 Treatment of potential secondary bacterial infections with antibacterial solutions or ointments, acetic acid soaks (1:1 ratio of vinegar to water) or oral antibiotics may be necessary. Surgical intervention is indicated when medical treatment fails. Excellent results have been reported with the use of an eponychial marsupialization technique, as well as removal of the entire nail and application of an antifungal-steroid ointment to the nail bed.3,6,8 Medicolegal More in AFP the nail becomes separated from the skin Workforce EMManchester Sexual Conditions 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. Autoimmune Diseases Avoid trimming cuticles or using cuticle removers Pyogenic paronychia is an inflammation of the folds of skin surrounding the nail caused by bacteria.[8]:254 Generally acute paronychia is a pyogenic paronychia as it is usually caused by a bacterial infection.[2] Related Articles How Paronychia Is Diagnosed  Drugs, Procedures & Devices Mind Psoriasis Home Remedies seborrheic dermatitis | paronychia how to treat seborrheic dermatitis | nail bed infection seborrheic dermatitis | paronychia toe
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