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10.10 Paronychia


Presentation

The patient will come with finger or toe pain that is either chronic and recurrent in nature or has developed rapidly over the past several hours, accompanied by redness and swelling of the nail fold. There are three distinct varieties:

What to do:

What not to do:

Discussion:

Whenever conservative therapy is instituted, the patient should be advised as to the advantages and disadvantages of that approach. If your patient is not willing or reliable enough to perform the required aftercare or cannot accept the potential treatment failure, then it would seem prudent to begin with the more aggressive treatment modes.

No single antibiotic will provide complete coverage for the array of bacterial and fungal pathogens cultured from paronychias. Theoretically, clincamycin or amoxicilln plus clavulanate should be the most appropriate antibiotics, but because the vast majority of paronychias are easily cured with simple drainage, systemic antibiotics are usually not indicated. In immunocompromised patients and those with peripheral vascular disease, cultures and antibiotics are indeed warranted.

Remain alert to the possible complications of a neglected paronychia such as osteomyelitis, septic tenosynovitis of the flexor tendon or a closed space infection of the distal finger pad (felon). Recurrent infections may be due to a herpes simplex infection (herpetic whitlow) or fungus (onchomycosis). Tumors like squamous cell carcinoma or malignant melanoma, cysts, syphilitic chancres, warts or foreign body granulomas can occasionally mimic a paronychia. Failure to cure a paronychia within four or five days should prompt specialized culture techniques, biopsy or referral.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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