Paronychia - Revision history

Rossdonaldson1: /* Background */

2023-11-08T18:12:30Z

Background

← Older revision		Revision as of 18:12, 8 November 2023
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	**Trauma allows entry of bacteria		**Trauma allows entry of bacteria
	**''[[S. aureus]]'' is most common, although ''[[S. pyogenes]]'', ''[[Pseudomonas pyocyanea]]'', and ''[[Proteus vulgaris]]'' are also common<ref name="Larios" />		**''[[S. aureus]]'' is most common, although ''[[S. pyogenes]]'', ''[[Pseudomonas pyocyanea]]'', and ''[[Proteus vulgaris]]'' are also common<ref name="Larios" />
	**Can lead to distal phalanx osteomyelitis even if drained appropriately		**Can lead to distal phalanx [[osteomyelitis]] even if drained appropriately

	{{Fingertip anatomy}}		{{Fingertip anatomy}}

Cmb23: /* Background */

2023-10-21T21:41:22Z

Background

← Older revision		Revision as of 21:41, 21 October 2023
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	**Trauma allows entry of bacteria		**Trauma allows entry of bacteria
	**''[[S. aureus]]'' is most common, although ''[[S. pyogenes]]'', ''[[Pseudomonas pyocyanea]]'', and ''[[Proteus vulgaris]]'' are also common<ref name="Larios" />		**''[[S. aureus]]'' is most common, although ''[[S. pyogenes]]'', ''[[Pseudomonas pyocyanea]]'', and ''[[Proteus vulgaris]]'' are also common<ref name="Larios" />
			**Can lead to distal phalanx osteomyelitis even if drained appropriately

	{{Fingertip anatomy}}		{{Fingertip anatomy}}

Rossdonaldson1: /* Management */

2021-05-27T15:59:15Z

Management

Rossdonaldson1: /* Management */

2021-05-27T15:56:40Z

Management

← Older revision		Revision as of 15:56, 27 May 2021
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	==Management==		==Management==
	===Acute===		===Acute===
	*More likely to be bacterial		''More likely to be bacterial''
	*If no fluctuance is identified:
	**Warm compresses, soaks, elevation		**Warm compresses, soaks, elevation
	**Antibiotic ointment TID x5-10 days (mild cases) ± topical steroid		*[[Incision and drainage]], if fluctuance or purulence is present
	**PO Antibiotics (more severe or persistent cases)<ref name="Larios" />
	***Augmentin BID x7 days '''OR'''
	***Clindamycin 150-450mg TID or QID x7 days '''OR'''
	***[[~~TMP-SMX DS~~]] ~~1-2 tab PO BID x7 days~~
	*If fluctuance or purulence is ~~identified:~~
	**Consider soaking hand for preparation		**Consider soaking hand for preparation
	**Consider [[digital block]]		**Consider [[digital block]]
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	***Incise parallel to nail (do NOT incise perpendicular to fluctulance)		***Incise parallel to nail (do NOT incise perpendicular to fluctulance)
	***Use iris scissors, flat tweezers, or #11 blade		***Use iris scissors, flat tweezers, or #11 blade
	**~~Have patient continue warm soaks at home to prevent re~~-~~accumulation~~		*[[Antibiotics]]
			**Antibiotic ointment TID x5-10 days (mild cases) ± [[topical steroid]]
			**PO Antibiotics (more severe or persistent cases)<ref name="Larios" />
			***[[Augmentin]] BID x7 days '''OR'''
			***[[Clindamycin]] 150-450mg TID or QID x7 days '''OR'''
			***[[TMP-SMX DS]] 1-2 tab PO BID x7 days

	===Chronic===		===Chronic===

Rossdonaldson1: /* Background */

2020-11-11T17:35:17Z

Background

← Older revision		Revision as of 17:35, 11 November 2020
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	==Background==		==Background==
	~~{{Fingertip anatomy}}~~
	*Inflammation/infection of the proximal or lateral nail folds<ref name="Larios">Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.</ref>		*Inflammation/infection of the proximal or lateral nail folds<ref name="Larios">Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.</ref>
	*Usually caused by direct or indirect minor trauma (e.g. nail-biting, manicures, hangnails, ingrown nail, dishwashing)		*Usually caused by direct or indirect minor trauma (e.g. nail-biting, manicures, hangnails, ingrown nail, dishwashing)
	**Trauma allows entry of bacteria		**Trauma allows entry of bacteria
	**''S. aureus'' is most common, although ''S. pyogenes'', ''Pseudomonas pyocyanea'', and ''Proteus vulgaris'' are also common<ref name="Larios" />		**''[[S. aureus]]'' is most common, although ''[[S. pyogenes]]'', ''[[Pseudomonas pyocyanea]]'', and ''[[Proteus vulgaris]]'' are also common<ref name="Larios" />

			{{Fingertip anatomy}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2020-04-29T20:25:12Z

Background

← Older revision		Revision as of 20:25, 29 April 2020
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	==Background==		==Background==
			{{Fingertip anatomy}}
	*Inflammation/infection of the proximal or lateral nail folds<ref name="Larios">Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.</ref>		*Inflammation/infection of the proximal or lateral nail folds<ref name="Larios">Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.</ref>
	*Usually caused by direct or indirect minor trauma (e.g. nail-biting, manicures, hangnails, ingrown nail, dishwashing)		*Usually caused by direct or indirect minor trauma (e.g. nail-biting, manicures, hangnails, ingrown nail, dishwashing)

Lyssa1219: /* Acute */

2020-04-17T16:02:56Z

Acute

← Older revision		Revision as of 16:02, 17 April 2020
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	***Incise parallel to nail (do NOT incise perpendicular to fluctulance)		***Incise parallel to nail (do NOT incise perpendicular to fluctulance)
	***Use iris scissors, flat tweezers, or #11 blade		***Use iris scissors, flat tweezers, or #11 blade
			**Have patient continue warm soaks at home to prevent re-accumulation

	===Chronic===		===Chronic===

Rossdonaldson1 at 22:39, 28 January 2020

2020-01-28T22:39:03Z

← Older revision		Revision as of 22:39, 28 January 2020
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	**''S. aureus'' is most common, although ''S. pyogenes'', ''Pseudomonas pyocyanea'', and ''Proteus vulgaris'' are also common<ref name="Larios" />		**''S. aureus'' is most common, although ''S. pyogenes'', ''Pseudomonas pyocyanea'', and ''Proteus vulgaris'' are also common<ref name="Larios" />

			==Clinical Features==
	[[File:Paronychia.jpg\|thumbnail\|Paronychia of middle digit]]		[[File:Paronychia.jpg\|thumbnail\|Paronychia of middle digit]]
			[[File:Infectionofcutical.jpg\|thumb\|Paronychia as a secondary infection from a splinter.]]
	~~==Clinical Features==~~
	[[File:Infectionofcutical.jpg\|thumb\|Paronychia as a secondary ~~infectino~~ from a splinter.]]
	*Rapid onset of erythema, edema, and pain of proximal or lateral nail folds<ref name="Larios" />		*Rapid onset of erythema, edema, and pain of proximal or lateral nail folds<ref name="Larios" />
	*Usually only affects one nail		*Usually only affects one nail

Rossdonaldson1: /* Clinical Features */

2020-01-28T22:26:38Z

Clinical Features

← Older revision		Revision as of 22:26, 28 January 2020
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	==Clinical Features==		==Clinical Features==
			[[File:Infectionofcutical.jpg\|thumb\|Paronychia as a secondary infectino from a splinter.]]
	*Rapid onset of erythema, edema, and pain of proximal or lateral nail folds<ref name="Larios" />		*Rapid onset of erythema, edema, and pain of proximal or lateral nail folds<ref name="Larios" />
	*Usually only affects one nail		*Usually only affects one nail

Kxl328: /* Chronic */

2018-10-12T04:39:03Z

Chronic

← Older revision		Revision as of 04:39, 12 October 2018
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	*Mainstay of therapy is avoidance of irritant		*Mainstay of therapy is avoidance of irritant
	*Consider topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks		*Consider topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks
			*Traditional treatments have been antifungals, but accumulating evidence suggests chronic paronychia is eczematous<ref>Relhan V et al. Management of Chronic Paronychia. Indian J Dermatol. 2014 Jan-Feb; 59(1): 15–20.</ref>
			**Topical steroids Rx to start in ED, with follow up for possible systemic steroids with PCP should be considered
			**Methylprednisolone aceponate cream 0.1%, over 3 weeks
			**OR betamethasone 17-valerate 0.1% for 3 weeks

	==Disposition==		==Disposition==

← Older revision		Revision as of 15:59, 27 May 2021
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	***Use iris scissors, flat tweezers, or #11 blade		***Use iris scissors, flat tweezers, or #11 blade
	*[[Antibiotics]]		*[[Antibiotics]]
	**~~Antibiotic~~ ointment TID x5-10 days (mild cases) ± [[topical steroid]]		**Triple antibiotic ointment TID x 5-10 days (mild cases) ± [[topical steroid]]
	**PO Antibiotics (more severe or persistent cases)<ref name="Larios" />		**PO Antibiotics (more severe or persistent cases)<ref name="Larios" />
	***[[Augmentin]] BID x7 days '''OR'''		***[[Augmentin]] BID x 7 days '''OR'''
	***[[Clindamycin]] 150-450mg TID or QID x7 days '''OR'''		***[[Clindamycin]] 150-450mg TID or QID x 7 days '''OR'''
	***[[TMP-SMX DS]] 1-2 tab PO BID x7 days		***[[TMP-SMX DS]] 1-2 tab PO BID x 7 days

	===Chronic===		===Chronic===
	*Multifactorial inflammation due to persistent irritation - may also have fungal component<ref name="Larios" />		''Multifactorial inflammation due to persistent irritation; may also have fungal component<ref name="Larios" />''
	*Mainstay of therapy is avoidance of irritant		*Mainstay of therapy is avoidance of irritant
	*Consider topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks		*Consider topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks
	*Traditional treatments have been antifungals, but accumulating evidence suggests chronic paronychia is eczematous<ref>Relhan V et al. Management of Chronic Paronychia. Indian J Dermatol. 2014 Jan-Feb; 59(1): 15–20.</ref>		*Traditional treatments have been [[antifungals]], but accumulating evidence suggests chronic paronychia is eczematous<ref>Relhan V et al. Management of Chronic Paronychia. Indian J Dermatol. 2014 Jan-Feb; 59(1): 15–20.</ref>
	**Topical steroids Rx to start in ED, with follow up for possible systemic steroids with PCP should be considered		**[[Topical steroids]] to start in ED, with follow up for possible systemic steroids with PCP should be considered
	**Methylprednisolone aceponate cream 0.1%, over 3 weeks		**Methylprednisolone aceponate cream 0.1%, over 3 weeks
	**OR betamethasone 17-valerate 0.1% for 3 weeks		**OR betamethasone 17-valerate 0.1% for 3 weeks