Paronychia

Background

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

Management

• 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 the need for drainage
• If fluctuance or pus is identified:

.18 After suppuration has occurred, the infection will exhibit either fluctuance or identifiable pus that will necessitate drainage. Minor infections can be treated with elevation of the perionychium or eponychium with a flat probe #11 blade (Figure 280-5) or needle slid along the surface of the nail.19 If only elevating the eponychium from the nail, this procedure can be performed without placing a digital block or providing analgesia.20 In general, only nonviable tissue can be incised without provoking pain.