Paronychia

Background

• Infection of lateral nail fold or perionychium
• Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails)

Diagnosis

Paronychia of middle digit

• 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

• Digital mixoid cyst

Workup

• May consider culturing pus drained

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

• Hand and finger infections

Source

Tintinelli