Paronychia: Difference between revisions
No edit summary |
No edit summary |
||
| Line 2: | Line 2: | ||
*Infection of lateral nail fold or perionychium | *Infection of lateral nail fold or perionychium | ||
*Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails) | *Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails) | ||
==Diagnosis== | |||
[[File:Paronychia.jpg|thumbnail|Paronychia of middle digit]] | |||
*Clinical | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Template:Hand Infection DDX}} | {{Template:Hand Infection DDX}} | ||
==Workup== | |||
NA | |||
==Treatment== | ==Treatment== | ||
| Line 16: | Line 23: | ||
**A larger than expected area of blanching, reflecting a collection of pus, may identify need for drainage | **A larger than expected area of blanching, reflecting a collection of pus, may identify need for drainage | ||
*If fluctuance or pus is identified: | *If fluctuance or pus is identified: | ||
**Incise area of greatest fluctuance | **Consider soaking hand for preparation | ||
**Consider [[digital block]] | |||
**Incise area of greatest fluctuance | |||
***Incise parallel to nail (do NOT incise perpendicular to fluctulance) | |||
***Use iris scissors, flat tweezers, or #11 blade | |||
***Insert small packing to allow for drainage | |||
===Chronic=== | ===Chronic=== | ||
Revision as of 19:37, 17 November 2014
Background
- Infection of lateral nail fold or perionychium
- Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails)
Diagnosis
- Clinical
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Workup
NA
Treatment
Acute
- more likely bacterial
- If no fluctuance is identified:
- Warm soaks, elevation
- TMP-SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d)
- If unclear if wound is fluctuant:
- Have pt apply pressure to distal aspect of affected digit
- A larger than expected area of blanching, reflecting a collection of pus, may identify need for drainage
- If fluctuance or pus is identified:
- Consider soaking hand for preparation
- Consider digital block
- Incise area of greatest fluctuance
- Incise parallel to nail (do NOT incise perpendicular to fluctulance)
- Use iris scissors, flat tweezers, or #11 blade
- Insert small packing to allow for drainage
Chronic
- more likely fungal
- XR to r/o FB/osteo
- vinegar/bleach soaks
- topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks
Disposition
- Wound check in 24-48hr
See Also
Source
Tintinelli