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Paronychia - Coggle Diagram
Paronychia
differential diagnosis
insect bite
fungal nail infection
finger tip injury
herpetic whitlow
staphylococcal whitlow
cancer
acute contact dermatitis
reactive arthritis
cutaneous candidiasis
dyshidrotic eczema
foreign object
myxoid cyst
pemphigus vulgaris
glomus tumour
management
apply moist heat or warm soaks for 10-15 minutes 3-4 times daily to alleviate pain, localised infection and hasten draining of pus
incision and drainage are recommended if a fluctuant pus collection or abscess has developed
consider prescribing topical ABX
consider prescribing a 7 day course of oral ABX if incision and drainage is not performed, was performed with significant pain
seek specialist advise if MRSA infection is known from swab
give self care advice, regular analgesia or NSAIDS, keep area dry and clean, avoid further trauma or manipulate nail, trim hanging nails,
if the person works with their hands in a moist environment advise that: increase risk of paronychia if frequently exposed to water, treatment is unlikely to be successful in wet or moist environment gloves should be worsen where possible, if the person is immunosuppressed advise to remain vigilant against minor trauma
follow up is not necessary as most paronychia drain spontaneously without the need for incision
if the paronychia is due to in growing toenail this must be addressed
diagnosis
take History: Clinical features pain and swelling at the base of the nail, localised pain/tenderness in the nail folds, usually affects one finger, may be a history of trauma to the nail 2-5 days earlier
Examine for: 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.
risk factors
Local - aggressive manicuring, artificial 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, hyperhidrosis, 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.