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Paronychia (Complications (Nail loss, Osteomyelitis
Distal phalynx,…
Paronychia
Complications
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Nail abnormalities
Ridging, discolouration, thickening
Pathophysiology
Types
Acute - sudden onset, last a few days
Chronic - insidious onset, last >6weeks
Infectious agents
Usually staph aureus
Others e.g. strep, pseudomonas, anaerobes
Mechanism
Barrier disruption/skin trauma near nail,
allowing entry of infectious organisms
Diagnosis
Examination
Hand examination
Erythematous, swollen, tender lateral/proximal nail folds,
may have visible collection of pus, may have abscess or extension under nail plate (subungual abscess)
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History
DH
Isotretinoin or other meds
that can dry out the skin, allergies
SH
Occupation, leisure activities,
smoking, alcohol, diet
PMH
Immunosuppression, DM, endocrine disorder
PC/HPC
Pain and swelling of fingernail/toenail,
usually just one finger, history of trauma
Management
Medical
Topical abx
Indication: minor, localised infection
E.g. fusidic acid
Oral abx
Indication: signs of cellulitis, fever, other comorbidities
E.g. flucloxacillin or clarithromycin
Analgesia
Indication: pain
E.g. paracetamol, NSAIDs
Surgical
I+D
Indication: fluctuant pus collection
MOA: in primary care or refer to surgical
unit/A+E per local facilities
Conservative
Information and advice
Warm soaks 3-4x/d to aid drainage
Keep area clean and dry
Avoid further trauma/manipulation
Return if worsens or become systemically unwell
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Risk factors
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Local
Aggressive manicuring
Artificial nails
Frequent water emmersion or excessive washing
Chemical irritants
Nail biting/finger sucking
Hang nails
Ingrown nails
Trauma
Pemphigus vulgaris
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