Chronic paronychia tends to be caused by repeated inflammation from irritants, moisture or allergens, and may involve multiple nails. Infection with fungus and bacteria may also occur. Paronychia may be seen in people with eczema or psoriasis, or as a side effect of a medication. Felon is an infection of the distal pulp space of the fingertip. While the cause is often unknown, minor trauma most commonly precedes infection. It is a clinical diagnosis based on the presence of local pain, swelling, induration, and erythema. Early stages of felon may be managed conservatively with analgesics and antibiotics. Later stages require incision and drainage. Complications include fingertip soft tissue necrosis and osteomyelitis. Email The Author Devitalized tissue should be debrided.  Medical Technology Procedures & Devices Experts News & Experts Any other medical problems that you may have not mentioned? This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests. Acute paronychiae are usually caused by Staphylococcus aureus and are treated with a first-generation cephalosporin or anti-staphylococcal penicillin. Broader coverage is indicated if other pathogens are suspected. Chronic paronychiae may be caused by Candida albicans or by exposure to irritants and allergens. Blistering distal dactylitis Nutrients and Nutritional Info Am Fam Physician. 2001 Mar 15;63(6):1113-1117. Teaching Manchester Course 2018 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. Psychiatry Advisor resuscitation My Profile linkedin In patients with acute paronychia, only one nail is typically involved.10 The condition is characterized by rapid onset of erythema, edema, and discomfort or tenderness of the proximal and lateral nail folds,11 usually two to five days after the trauma. Patients with paronychia may initially present with only superficial infection and accumulation of purulent material under the nail fold, as indicated by drainage of pus when the nail fold is compressed12,13 (Figure 2). An untreated infection may evolve into a subungual abscess, with pain and inflammation of the nail matrix.11 As a consequence, transient or permanent dystrophy of the nail plate may occur.10 Pus formation can proximally separate the nail from its underlying attachment, causing elevation of the nail plate.10,11 Recurrent acute paronychia may evolve into chronic paronychia.7,12 Chronic paronychia is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens.12,19–21 This disorder can be the result of numerous conditions, such as dish washing, finger sucking, aggressively trimming the cuticles, and frequent contact with chemicals (e.g., mild alkalis, acids). Iain Beardsell. Pain and Suffering in the ED. #SMACCGold Herpetic whitlow: Antiviral drugs such as acyclovir (Zovirax) may shorten the duration of illness. Pain medication is often needed. The wound must be properly protected to prevent a secondary bacterial infection and to prevent you from infecting other sites on your body or other people. Incision and drainage is not proper and, if done, may actually delay healing. What you should be alert for in the history Home Diseases and Conditions Paronychia What links here Disorders of skin appendages (L60–L75, 703–706) Simon Carley #SMACC2013 Educational Leadership and Subversion Clotrimazole cream (Lotrimin) Paronychia can be either acute or chronic depending on the speed of onset, the duration, and the infecting agents. Email Address Sign Up Journal Club Subungual hematoma (smashed fingernail, blood under the nail) Human factors paronychia:  infection of the folds of skin surrounding a fingernail Do Probiotic Supplements Help? 1. Overview Diseases & Conditions Acute: The clinical picture may be very variable but in principle there is redness, with or without pus (around the nail plate or beneath the nail bed), and swelling around the nail plates (usually lateral and or proximal nail folds) (Figure 1). Acute paronychia causes warmth and variable pain along the nail margin; mild pressure on the nail folds may provoke severe pain. Prescription Medicines PSORIASIS Acute and chronic paronychia Health Care According to Flickr, where I found this image, text before the picture reads: Ciclopirox topical suspension (Loprox TS) Finger infections Allergic contact dermatitis or primary irritation due to certain nail polish or latex or excessive repeated habitual wet products   This article exemplifies the AAFP 2008 Annual Clinical Focus on infectious disease: prevention, diagnosis, and management. Trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim, Septra)* Rick Body. Using High sensitivity Troponins in the ED. Blistering distal dactylitis Appointments & AccessPay Your BillFinancial AssistanceAccepted InsuranceMake a DonationRefer a PatientPhone DirectoryEvents Calendar 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 Med Ed Citation Depending on the cause of the infection, paronychia may come on slowly and last for weeks or show up suddenly and last for only one or two days. The symptoms of paronychia are easy to spot and can usually be easily and successfully treated with little or no damage to your skin and nails. Your infection can become severe and even result in a partial or complete loss of your nail if it’s not treated. There was an error. Please try again. JC: Is your name on the list? Supplements 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. Peer reviewers VIEW ALL  Table 1 ACNE Jump up ^ "Bar Rot". The Truth About Bartending. January 27, 2012. Archived from the original on 2013-03-22. For most cases, the diagnosis of infection is made by history and physical exam. X-rays are a rapid and cost effective way to identify bony changes and radiopaque foreign bodies. More complex imaging studies should be reserved for situations where the diagnosis remains unclear despite adequate examination and initial treatment, or if the patient does not respond to appropriate management. Special Report America's Pain: The Opioid Epidemic Body-Focused Repetitive Behavior Follow up  Iain Beardsell. Pain and Suffering in the ED. #SMACCGold 101 personal & philosophical experiments in EM A The SGEM with Ken Milne SN declares that she has no competing interests. Simon Carley #SMACC2013 Educational Leadership and Subversion Psoriasis on Your Hands and Feet Is Horrible. Learn How to Treat It Cracked Heels and Dry Skin on Feet: Know the Facts Figure 2. Psoriasis Home Remedies What links here My Profile FIGURE 2. Wear waterproof gloves when immersing your hands in detergents, cleaning fluids, or strong chemicals. Attachments:8 FIGURE 2. Wikipedia store The dagnosis is usually determined by the clinical appearance. The histological feature is not specific, showing an acute or chronic nonspecific inflammatory process. Sometimes there is an abscess formation around the nail folds. Ultrasound and culture from purulent material will help to decide if and what systemic antibiotic should be given. 875 mg/125 mg orally twice daily for seven days All site content, except where otherwise noted, is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License 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. Resus.me Exercise and Fitness Nail Structure and Function Patients in an immunocompromised state may develop a hand infection from hematogenous spread from another site. If you have diabetes, make sure it is under control. << Previous article The Cardiology Advisor St.Emlyn’s on facebook 500 mg/125 mg orally three times daily for seven days Avoid soaking your hands in water for prolonged periods time (or, again, use waterproof gloves). Commonly involves the thumb and index finger Chronic infection is likely to last for weeks or months. This can often be more difficult to manage. So early treatment is important. Procedures & Devices Do I need to take an antibiotic? Sign Up Appointments 216.444.5725 How to Recognize and Treat an Infected Hangnail Social Media Staff C Deep space infections: Much like flexor infectious tenosynovitis, this can require emergency care. If the infection is mild, then only oral antibiotics may be needed. If more severe, a hand surgeon should evaluate the wound and IV antibiotics begun. Often these wounds will require incision and drainage followed by a course of antibiotics. Export to EPUB As much as possible, try to avoid injuring your nails and the skin around them. Nails grow slowly. Any damage to them can last a long time. Drug Typical dosage Comments  Menu  Close Psychotic Disorders List Careers Sign In Advertisement SORT: KEY RECOMMENDATIONS FOR PRACTICE Rick Body. Using High sensitivity Troponins in the ED. Any trauma to the nail or skin surrounding the nail such as aggressively trimming or manicuring your nails can create a way for bacteria to enter and cause an infection. People who have jobs that frequently expose their hands to water or irritants such as chemicals used in washing dishes are at an increased risk of chronic paronychia. Persons with diabetes or diseases that compromise the immune system are more likely to develop infections. Avoid contact with eyes; if irritation or sensitivity develops, discontinue use and begin appropriate therapy MS and Depression: How Are They Linked? Keep reading: How to treat an ingrown fingernail » Most of the time, paronychia is no big deal and can be treated at home. In rare cases, the infection can spread to the rest of the finger or toe. When that happens, it can lead to bigger problems that may need a doctor's help. Daniel CR 3rd, Iorizzo, M, Piraccini, BM, Tosti, A. "Grading simple chronic paronychia and onycholysis". Int J Dermatol. vol. 45. 2006 Dec. pp. 1447-8. 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