9. Lee HE, Wong WR, Lee MC, Hong HS. Acute paronychia heralding the exacerbation of pemphigus vulgaris. Int J Clin Pract. 2004;58(12):1174–1176. In patients with a chronic paronychia that is unresponsive to therapy, unusual and potentially serious causes of abnormal nail and skin appearance, such as malignancy, should be explored.3,10 These patients should be referred to hand surgeons for surgical drainage and treated with antibiotics covering Staph. aureus in the first instance. Activity The finger is held in flexion After your initial soak, cut the hangnail off. Eliminating the rough edge of the hangnail might reduce further infection. Make sure to cut it straight with cuticle clippers. Subscribe Next Steps - Follow-up 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. Shaimaa Nassar, MBBCH, Dip(RCPSG) Skin Care & Cleansing Products About Us What Meningitis Does to Your Body Parents site Herpetic whitlow is discussed in herpes simplex virus infections. Arthritis and Carpal Tunnel Syndrome Living Healthy What is paronychia? Body-Focused Repetitive Behavior Dictionary Nail Infection (Paronychia) Menu Figure: paronychia  (http://en.wikipedia.org/wiki/Paronychia#mediaviewer/File:Paronychia.jpg) 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 DIMITRIS RIGOPOULOS, MD, is clinical associate professor of dermatology and venereology at the University of Athens (Greece) Medical School. He also is medical director of the nail unit at Andreas Sygros Hospital in Athens. Dr. Rigopoulos received his medical degree from the University of Athens Medical School and completed a dermatology and venereology residency at Andreas Sygros Hospital.... Restrictions 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. — Don't try to puncture or cut into an abscess yourself. Doing that can lead to a more serious infection or other complications. The doctor may need to drain the abscess and possibly prescribe antibiotic medications to treat the infection. Once an abscess is treated, the finger or toe almost always heals very quickly. Breathe Better at Home My WebMD Pages This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Medical Technology WebMD Health Record Your doctor will examine your hangnail for signs of infection. They may be able to diagnose the hangnail just by looking at it. In other cases, your doctor may want to take a sample of any pus in the infected area to send to a lab for further analysis. Your fingernails can reveal a lot about the state of your health. Conditions ranging from stress to thyroid disease may be causing changes in your… Am Fam Physician. 2008 Feb 1;77(3):339-346. Advanced Major Incidents How to Spot and Treat Cellulitis Before It Becomes a Problem NY Do Probiotic Supplements Help? Warm water soaks 3 to 4 times a day can help reduce pain and swelling if you have acute paronychia. Your doctor may prescribe antibiotics if your paronychia is caused by bacteria. He or she may prescribe antifungal medicines if your infection is caused by a fungus. for Parents Teamwork Paronychia at DermNet.NZ Elevated compartment pressure results in significant pain relative to the (small) amount of pus. In addition, the gradient between capillary pressure and tissue pressure is decreased; the resulting decrease in perfusion can lead to tissue necrosis. Furthermore, because the osteocutaneous ligaments attach to the distal phalanx itself, osteomyelitis (infection of the bone) can occur. Ignoring an infected hangnail can make your condition worse. In rare situations, the infection may spread to other parts of your body if left untreated. Contact your doctor if you have pus around or under the nail or if the infection doesn’t get better within a week. Candida albicans (95 percent), atypical mycobacteria, gram-negative rods Acknowledgements Home Sports 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. Paronychia: acute and chronic (nail disease, felon/whitlow) Case history 24. Ogunlusi JD, Oginni LM, Ogunlusi OO. DAREJD simple technique of draining acute paronychia. Tech Hand Up Extrem Surg. 2005;9(2):120–121. Autoimmune diseases, such as psoriasis pemphigus vulgaris, scleroderma, lupus erythematosus, etc © 2018 American Academy of Family Physicians Acute and Chronic Paronychia Paronychia: A history of nail biting may aid the diagnosis. The key to preventing disability and possible loss of the finger is early and appropriate treatment. If any signs and symptoms are present, you should contact your doctor at once. Psoriasis Pill Identifier submit site search 250 mg orally twice daily for 10 days biopsy of skin/bone #FOAMed CAP7 CAP27 cardiac CC3 CC5 CC8 CC12 CC15 CC16 CC20 CC21 CC23 CC24 CC25 chest pain CMP2 CMP3 CMP4 communication critical appraisal diagnosis Emergency Medicine FOAMed FOAMped FRCEM HAP8 head injury HMP3 journal club management med ed Medical education paediatrics paeds pediatrics PMP4 podcast research resuscitation sepsis SMACC social media St.Emlyn's trauma Dermatology Advisor Twitter Sugar and Sugar Substitutes Slideshows Stop Infestations Mental Health Classification D Important information that your doctor will need to know will include the following: In flexor tenosynovitis, the infection is within the flexor tendon sheath. This infection is particularly harmful because bacterial exotoxins can destroy the paratenon (fatty tissue within the tendon sheath) and in turn damage the gliding surface of the tendon. In addition, inflammation can lead to adhesions and scarring, and infection can lead to overt necrosis of the tendon or the sheath. An infection of the cuticle secondary to a splinter 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 DERMATOLOGY ADVISOR TWITTER Information from references 3, 10 through 13, and 17 through 22. SURGICAL TREATMENT Slideshow Supplements for Better Digestion  ·  Powered by Atlassian Confluence , the Enterprise Wiki 250 mg orally twice daily for 10 days Figure Proximal and distal incisions have been made, allowing adequate drainage of the flexor tendon sheath. Avoid trimming cuticles or using cuticle removers Your feedback has been submitted successfully. Clinical Charts Simon Carley. What to Believe: When to Change. #SMACCGold Copyright & Permissions myhealthfinder 7 Ways You're Wrecking Your Liver This content is owned by the AAFP. 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