Paronychia: Difference between revisions
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{{Template:Hand Infection DDX}} | {{Template:Hand Infection DDX}} | ||
==Workup== | ==Diagnosis== | ||
===Workup=== | |||
*May consider culturing pus drained | *May consider culturing pus drained | ||
===Evaluation== | |||
*Usually a clinical diagnosis | |||
==Treatment== | ==Treatment== | ||
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===Chronic=== | ===Chronic=== | ||
*more likely fungal | *more likely fungal | ||
* | *Plain X-ray to rule out [[foreign body]] or [[osteo]] | ||
*vinegar/bleach soaks | *vinegar/bleach soaks | ||
*topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks | *topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks | ||
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*[[Hand and finger infections]] | *[[Hand and finger infections]] | ||
== | ==References== | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 07:54, 19 August 2015
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
Diagnosis
Workup
- May consider culturing pus drained
=Evaluation
- Usually a clinical diagnosis
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
- Plain X-ray to rule out foreign body or osteo
- vinegar/bleach soaks
- topical antifungals vs Diflucan 150mg po qweek x 4-6 weeks
Disposition
- Wound check in 24-48hr