Patient information: See related handout on chronic paronychia, written by the authors of this article. Dermatology & Plastic Surgery Institute Critical Care Horizons Next: Diagnosis and Tests Teens site Copyright & Permissions View PDF Living Well Herpetic whitlow: The fingertip area will be red and tender. A burning or itching sensation may be present in the area. There may be mild swelling, but not as extensive as in the felon. There may be a single or many open wounds in the area affected. These open wounds often occur in clusters after the formation of a small blisterlike lesion. The fluid in these lesions is usually clear in appearance but may be slightly cloudy. You may also have a low-grade fever and have swollen and tender lymph nodes in the area. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Kept Your Wisdom Teeth? Consultant Dermatologist The hand is susceptible to infection by virtue of its intimate contact with the outside world, its great surface area and its propensity for injury. That is, the hand is exposed frequently to infectious organisms, and these organisms are frequently given a point of entry. Probably not healthy patients, but this open access case report describes disseminated Fusarium infection in a patient with neutropenia from AML, thought to have arisen from a toenail paronychia. Diagnosis of chronic paronychia is based on physical examination of the nail folds and a history of continuous immersion of hands in water10; contact with soap, detergents, or other chemicals; or systemic drug use (retinoids, antiretroviral agents, anti-EGFR antibodies). Clinical manifestations are similar to those of acute paronychia: erythema, tenderness, and swelling, with retraction of the proximal nail fold and absence of the adjacent cuticle. Pus may form below the nail fold.8 One or several fingernails are usually affected, typically the thumb and second or third fingers of the dominant hand.13 The nail plate becomes thickened and discolored, with pronounced transverse ridges such as Beau's lines (resulting from inflammation of the nail matrix), and nail loss8,10,13 (Figure 4). Chronic paronychia generally has been present for at least six weeks at the time of diagnosis.10,12 The condition usually has a prolonged course with recurrent, self-limited episodes of acute exacerbation.13 When abscess or fluctuance is present, efforts to induce spontaneous drainage or surgical drainage become necessary. If the paronychia is neglected, pus may spread under the nail sulcus to the opposite side, resulting in what is known as a “run-around abscess.”8 Pus may also accumulate beneath the nail itself and lift the plate off the underlying matrix. These advanced cases may require more complex treatment, including removal of the nail to allow adequate drainage. Visit WebMD on Twitter Candida albicans and/or Pseudomonas may be cultured. Treating the underlying dermatitis is very important: avoidance of further irritants together with emollient use is a good start. Topical steroids are first-line therapy but culture is really important here: steroids are usually given with topical antifungal but oral antifungal such as itraconazole or fluconazole may be indicated if C.albicans is isolated. Treatment of chronic paronychia includes avoiding exposure to contact irritants and appropriate management of underlying inflammation or infection.12,20 A broad-spectrum topical antifungal agent can be used to treat the condition and prevent recurrence.22 Application of emollient lotions to lubricate the nascent cuticle and the hands is usually beneficial. One randomized controlled trial assigned 45 adults with chronic paronychia to treatment with a systemic antifungal agent (itraconazole [Sporanox] or terbinafine [Lamisil]) or a topical steroid cream (methylprednisolone aceponate [Advantan, not available in the United States]) for three weeks.21 After nine weeks, more patients in the topical steroid group were improved or cured (91 versus 49 percent; P < .01; number needed to treat = 2.4). Prevention & Treatment Recurrent manicure or pedicure that destroyed or injured the nail folds Pulmonology Advisor Nail injuries Men's Health Rosacea Children's Vaccines Development of red streaks along the skin If you have been prescribed antibiotics for a finger infection, you must follow the directions and take them for the prescribed time period. Appointments & Locations Lung Cancer Risks: Myths and Facts Legal Notice Sugar and Sugar Substitutes You may also need to have blisters or abscesses drained of fluids to relieve discomfort and speed healing. This should be done by your doctor in order to avoid spreading the infection. When draining it, your doctor can also take a sample of pus from the wound to determine what is causing the infection and how best to treat it. STAMATIS GREGORIOU, MD, is a dermatologist-venereologist at the University of Athens Medical School and at the nail unit and hyperhidrosis clinic at Andreas Sygros Hospital. He received his medical degree from the University of Athens Medical School and completed a dermatology and venereology residency at Andreas Sygros Hospital. More in Skin Health Anatomic relationships of flexor sheaths to deep fasical spaces should be kept in mind. Contiguous spread can result in a “horseshoe abscess”: from small finger flexor sheath to the thumb flexor sheath via connection between the radial and ulnar bursae. Conventional remedies for toenail fungus often cause side effects, leading many people to look for alternatives. Here are 10 remedies to try at home… Acute paronychia: The major causative organism is Staphylococcus aureus. Less common organisms are Streptococcus species, Pseudomonas or Proteus spp. References: for Teens Advertise Second Trimester -Wearing vinyl gloves for wet work Long-term corticosteroid use 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. What Is Tinea Versicolor, and Do I Have It? Comparison of Acute and Chronic Paronychia The philosophy of EM Clinical recommendation Evidence rating References Avoid finger sucking Who funds St.Emlyn’s? Famciclovir (Famvir)† For Advertisers Table 2 News & Experts From out of town? Chronic (Fungal) Paronychia Adjust dosage in patients with severe hepatic dysfunction; associated with severe and possibly fatal colitis; inform patient to report severe diarrhea immediately Bent Fingers? Overview  Emergency Medicine Theory 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. -Wearing vinyl gloves for wet work Resus & Crit Care Mental Health Our expert physicians and surgeons provide a full range of dermatologic, reconstructive and aesthetic treatments options at Cleveland Clinic. Don't push your cuticles back, trim them, or use cuticle remover. Damaging your cuticles gives bacteria a way to get into your skin and cause an infection. SMACC Creep The St.Emlyn's podcast  FEEDBACK The following individuals have contributed to this page: Your doctor can diagnose paronychia with a simple physical exam. Special tests aren’t usually necessary, but your doctor may want to send a sample of fluid or pus to a laboratory to identify the bacteria or fungus that is causing the infection. Slideshow Working Out When You're Over 50 People with the following conditions tend to have more extensive paronychial infections and may need to be treated with a prolonged course of antibiotics: Criteria 31. Gorva AD, Mohil R, Srinivasan MS. Aggressive digital papillary adenocarcinoma presenting as a paronychia of the finger. J Hand Surg [Br]. 2005;30(5):534. See the following for related finger injuries: Selected international, national and regional presentations from the St.Emlyn’s team. Selected international, national and regional presentations from the St.Emlyn’s team. seborrheic dermatitis | infected cuticle seborrheic dermatitis | paronychia how to treat seborrheic dermatitis | nail bed infection
Legal | Sitemap