PARONYCHIA Flashcards
(1) Paronychia is an acute inflammatory process, with or without abscess formation, that
involves the proximal and lateral nail folds and that has been present for less than six
weeks.
(2) Most commonly caused by Staphylococcus aureus, Streptococcus pyogenes infection
in the periungual tissues by minor mechanical or chemical traumas that disrupt the nail
fold barrier.
(3) Common favoring factors include manicuring, nail biting, thumb sucking, and picking
at a hangnail.
(4) Acute paronychia of the toes occurs in most cases in association with ingrown toenails.
(5) Paronychia is the most common infection of the hand, representing 35% of all hand
infections in the United States.
Paronychia
Paronychia Presentation
(1) Acute paronychia presents with localized pain and tenderness. The nail fold appears
erythematous and inflamed, and a collection of pus usually develops.Early in the
course, cellulitis alone may be present. An abscess can form if the infection does not
resolve quickly.
(2) Develops along the nail margin (proximal and lateral nail folds), manifesting over
hours to days with pain, warmth, redness and swelling.
(3) Pus accumulates behind the cuticle, sometimes spreading beneath the nail or deeper
into the lateral nail folds.
Paronychia Treatment
(1) Early treatment with warm compresses or soaks.
(2) Antibiotic therapy if warranted that includes coverage for Staph and strep.
(3) Bactrim/Septra DS in areas where MRSA is common and based on results of sensitivity
testing.
(4) Fluctuant or visible pus should be drained using scalpel blade inserted between the nail
and nail fold.
(5) Skin incision is unnecessary.
Differential Diagnosi
(1) Psoriasis
(2) Onycholysis
(3) Proximal Onychomycosis
(4) Squamous Cell Carcinom
Labs/Studies/Imaging
Gram Stain and KOH based on exam findings.
Disposition
Light duty may be indicated based on occupation and treatment.
Complications
(1) Further extension of the infection and deeper involvement.
(2) Nail distortion in chronic infections
