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Paronychia - Coggle Diagram
Paronychia
Differential diagnosis
Fungal nail infections
Herpetic whitlow
Insect bites or stings
Cancer
Finger-tip injuries
Psoriasis
Staphylococcal whitlow
Reative arthritis
Acute contact dermatitis
Dyshidrotic eczema
Cutaneous candidiasis
Pemphigus vulgaris
Foreign body
Glomus tumour
Myxoid cyst
Management
Consider prescribing a 7-day course of oral antibiotics if incision/drainage is not performed or performed by there is significant pain or involvement of extended area of tissue, there are signs of cellulitis, fever or other co-morbidities.
Seek specialist advise if the person is known to have MRSA
Consider prescribing topical antibiotics (such as fucidic acid cream) for minor, localised infection
Give the person self-care advice: use of paracetamol/NSAID for pain relief, keep affected clean/dry, avoid further trauma of the nail, trim hang nails, if person works with their hands in a wet environment advise to wear gloves to protect fingers.
Incision and drainage are recommended if a fluctuant pus collection or abscess has developed
Follow up is not usually necessary.
Advise to apply moist heat (warm soacks) for 10-15 minutes 3/4 times per day to alleviate pain, localize the infection and hasten draining of the pus.
If due to an ingrowing toenail this must be addressed.
Swab - if enlarging, inflamation in surrounding tissue, recurrent, not responding to treatment, systemically unwell, MRSA, doubt about diagnosis, immunosuppressed or person has diabetes.
In recurrent cases - consider alternative diagnosis, exclude underlying cause, swab the lesion, consider x-ray to assess for osteomyelitis, give self-care advice.
Diagnosis
Examination: Lateral/proximal nail folds red/tender/swollen, visual collection of pus may be present. Severe cases - extension to the proximal nail edge, abscess formation with fluctuance, extension under the nail plate. Herpes simplex - lancinating pain, presence of vesicles or herpetiform arrange of pustules/vesicles.
Assess for the presence of pus or fluctuance.
History: Clinical features pain and swelling at the base of the nail, localised pain/tendernes in the nail folds, usually affects one finger, may be a history of trauma to the nail 2-5 days earlier.
Risk factors
Local - aggressive manicuring, artifical nail placement, frequent hand immersion in water, excessive hand washing, chemical irritant exposure, finger sucking and nail biting, hang nail, ingrown nail, trauma and pemphigus vulgaris.
Systemic - obesity, hyperhydrosis, diabetes mellitus, polyendocrinopathy, immunosuppression, retroviral use, oral retinoid use which dries the skin, chemotherapy drugs.
Definition: Paronychia is inflammation of the folds of tissue surrounding the nail. It is caused by barrier disruption or trauma, which allows for entry of infecting organism.