Paronychia: Difference between revisions
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*Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails) | *Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails) | ||
==Differential Diagnosis== | |||
{{Template:Hand Infection DDX}} | |||
==Treatment== | ==Treatment== | ||
===Acute=== | ===Acute=== | ||
*more likely bacterial | *more likely bacterial | ||
*If no fluctuance is identified: | *If no fluctuance is identified: | ||
**Warm soaks, elevation | **Warm soaks, elevation | ||
**TMP | **[[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: | *If unclear if wound is fluctuant: | ||
**Have pt apply pressure to distal aspect of affected digit | **Have pt apply pressure to distal aspect of affected digit | ||
Revision as of 05:36, 21 March 2014
Background
- Infection of lateral nail fold or perionychium
- Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails)
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
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:
- Incise area of greatest fluctuance w/ #11 blade
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