Appointments 216.444.5725 This article was contributed by: familydoctor.org editorial staff Prevention & Treatment Definition: soft tissue infection around a fingernail Diabetes Red, hot, tender nail folds, with or without abscess News & Current events Medical Treatment In patients with recalcitrant chronic paronychia, en bloc excision of the proximal nail fold is effective. Simultaneous avulsion of the nail plate (total or partial, restricted to the base of the nail plate) improves surgical outcomes.8,32 Alternatively, an eponychial marsupialization, with or without nail removal, may be performed.33 This technique involves excision of a semicircular skin section proximal to the nail fold and parallel to the eponychium, expanding to the edge of the nail fold on both sides.33 Paronychia induced by the EGFR inhibitor cetuximab can be treated with an antibiotic such as doxycycline (Vibramycin).28 In patients with paronychia induced by indinavir, substitution of an alternative antiretroviral regimen that retains lamivudine and other protease inhibitors can resolve retinoid-like manifestations without recurrences.25 microscopic or macroscopic injury to the nail folds (acute) Avoid contact with eyes; if irritation or sensitivity develops, discontinue use and begin appropriate therapy Causes Endocrinology Advisor Figure: a punch to the tooth may inadvertently lacerate the skin over the MCP joint and introduce oral flora into the joint  ONGOING Medically reviewed by Deborah Weatherspoon, PhD, RN, CRNA, COI on January 12, 2017 — Written by Natalie Silver Brain Fog The most common cause of acute paronychia is direct or indirect trauma to the cuticle or nail fold. Such trauma may be relatively minor, resulting from ordinary events, such as dishwashing, an injury from a splinter or thorn, onychophagia (nail biting), biting or picking at a hangnail, finger sucking, an ingrown nail, manicure procedures (trimming or pushing back the cuticles), artificial nail application, or other nail manipulation.3–5 Such trauma enables bacterial inoculation of the nail and subsequent infection. The most common causative pathogen is Staphylococcus aureus, although Streptococcus pyogenes, Pseudomonas pyocyanea, and Proteus vulgaris can also cause paronychia.3,6,7 In patients with exposure to oral flora, other anaerobic gram-negative bacteria may also be involved. Acute paronychia can also develop as a complication of chronic paronychia.8 Rarely, acute paronychia occurs as a manifestation of other disorders affecting the digits, such as pemphigus vulgaris.9 Mupirocin ointment (Bactroban) myCME Paronychia: The offending bacteria are usually staphylococcal and streptococcal organisms. Rarely, a fungus causes this infection, which usually begins as a hangnail. Often a person will attempt to bite off the piece of nail that is at the corner. This results in an open wound that allows the bacteria found on the skin and the bacteria found in the mouth to infect the wound. The infection can then spread to the surrounding tissue next to the nail and cuticle. Use a topical antibiotic cream on the infected hangnail for a few days. After applying the cream, cover the area with a bandage. 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 Hide/Show Comments Facebook There is sometimes a small collection of pus between the nail and the paronychium, unable to escape due to the superficial adhesion of the skin to the nail. Untreated for a period of time, the paronychia may evolve into associated cellulitis with or without ascending lymphangitis, or chronic paronychia. About WebMD #badEM Pulmonology Advisor Finger and Hand Infections CM Edits.docx Your Nails, Your Health Authors VIEW ALL  The metacarpophalangeal and interphalangeal joints are closed, relatively avascular spaces. Infection can reach the joint space via direct penetration or hematogenous spread. Definition: distal pulp space infection of the fingertip Chronic: Clinical features of chronic paronychia are similar to those associated with acute paronychia, but usually there is no pus accumulation (Figure 2). In the chronic phase there are several changes in the plate, such as thick, rough, ridges or other nail deformations. 7. Prevention Less common nowadays, prosector’s paronychia was so-called because it was seen in anatomists and dissectors – people with lots of hand-in-corpse time. It might present as a chronic, painless paronychia more visually in-keeping with the acute type and/or refractory to acute paronychia treatment. The giveaway is usually axillary lymphadenopathy, biopsy of which grows Mycobacterium tuberculosis. As such, this is a systemic manifestation of TB infection and should be treated with systemic TB meds You're not likely to get paronychia in a toe (unless you have an ingrown toenail). But fingernail paronychia is one of the most common hand infections there is Diagnosis & Tests How to treat an infected hangnail Reddit Name Quiz: Fun Facts About Your Hands Free trial Attachments 6. Brook I. Paronychia: a mixed infection. Microbiology and management. J Hand Surg [Br]. 1993;18(3):358–359. Systemic fever/chills Patient Rights © 2005 - 2018 WebMD LLC. All rights reserved. Paronychia can occur with diabetes, drug-induced immunosuppression,[6] or systemic diseases such as pemphigus.[7] Development of a single, purulent blister (1–2 cm) -Wearing vinyl gloves for wet work How can my doctor tell if I have paronychia? Causes of Erectile Dysfunction The other common management strategy is to excise a portion of the nail to allow pus drainage. If you are going to be cutting things, do perform a ring or digital block first and allow time for the local anaesthetic to work. Remember from your vast pharmacology knowledge that most local anaesthetics as weak bases and are unable to cross lipid membranes in acidic conditions – so local infiltration of infected tissues does not work (read more here). High doses may cause bone marrow depression; discontinue therapy if significant hematologic changes occur; caution in folate or glucose-6-phosphate dehydrogenase deficiency Food & Fitness 25. Garcia-Silva J, Almagro M, Peña-Penabad C, Fonseca E. Indinavir-induced retinoid-like effects: incidence, clinical features and management. Drug Saf. 2002;25(14):993–1003. Virchester Journal Club 2014. St.Emlyn’s CLINICAL EVIDENCE << Previous article The Causes of Paronychia Psoriasis on Your Hands and Feet Is Horrible. Learn How to Treat It pain, swelling, drainage (acute) 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: pain, swelling, drainage (acute) High Blood Pressure 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. Skin Care & Cleansing Products TREATMENT OPTIONS and OUTCOMES 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 tinea versicolor | vitiligo treatment tinea versicolor | coresatin tinea versicolor | nail infection
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