Paronychia, Acute

Notes

## Basic introduction

  • It is a soft tissue bacterial or fungal infection around a fingernail
  • It is the commonest cause of hand infection
  • The risk factors for acute paronychia include[a][b]
  • Direct or indirect trauma to the cuticle or nail fold
  • Nail biting
  • Sucking of fingers
  • Washing/detergents
  • Splinter or thorn injury to a finger
  • An ingrown nail
  • Treatment with oral retinoid as it dries the skin

## Causes of acute paronychia

  • Staphylococcus aureus
  • Streptococci
  • Pseudomonas
  • Proteus
  • Gram negative bacilli
  • Herpes simplex virus
  • Dermatophytes
  • Yeasts
Symptoms
  • Red skin
  • Warmth /hot skin
  • Pain along the nail margin
  • Pus along the nail margin and occasionally beneath the nail.
Diagnosis
  • Clinical review
Differential
  • Herpetic whitlow
  • Proximal onychomycosis
  • Psoriasis
  • Pyoderma gangrenosum
  • Pyogenic granuloma
  • Reiter syndrome
  • Squamous cell carcinoma
Prevention
  • Avoid the risk factors mentioned previously
Management
  • Antibiotics [such as clindamycin or amoxicillin-clavulanic acid] and /or antifungal when there is no abscess.
  • Antibiotic can be used with or without topical corticosteroids
  • In the presence of abscess, incision and drainage
  • Surgical debridement
  • Warm water soak 3-4 times or warm compresses
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