Failure to comply may result in legal action. 6(March 15, 2001)
Treatment options for acute paronychias include warm-water soaks, oral antibiotic therapy and surgical drainage. Drains are not necessary. Paronychia is inflammation of the fingers or toes in one or more of the three nail folds. Treatment usually involves antibiotic medicines for germ (bacterial) infections. Paronychia is one of the most common infections of the hand. Treatment may also help prevent the infection from spreading to nearby tissue. 1998;14:547–55,viii. Immediate, unlimited access to all AFP content. Weinstein D, C. albicans may be cultured from 95 percent of cases of chronic paronychia.6 Other pathogens, including atypical mycobacteria, gram-negative rods and gram-negative cocci, have also been implicated in chronic paronychia (Table 1).6, Treatment of chronic paronychia primarily involves avoiding predisposing factors such as exposure to irritating substances, prolonged exposure to water, manicures, nail trauma and finger sucking. You may also need surgery to drain pus or remove your nail and the tissue around it. The nail fold is the skin around your fingernails and toenails. Paronychia is an infection of your nail fold caused by bacteria or a fungus. Copyright © 2001 by the American Academy of Family Physicians. Hochman LG. With paronychia, your nail fold may be painful. In cases of chronic paronychia, it is important that the patient avoid possible irritants. Ask your caregiver for more information about other chemicals that may cause paronychia. This matrix is the “root” of the nail, and its distal portion is visible on some nails as the half-moon–shaped structure called the lunula.1 The nail plate is hard and translucent, and is composed of dead keratin.2 The plate is surrounded by the perionychium, which consists of proximal and lateral nail folds, and the hyponychium, the area beneath the free edge of the nail1 (Figure 1). In this Paronychia surgical treatment the sore is cut with a sharp surgical knife to drain the pus. 1995;34:385–6. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Paronychia, also called perionychia, is an infection and inflammation (redness, pain, and swelling) of your nail fold. A paronychia is usually the result of frequent trauma, tight fitting apparel (e.g., gloves, pantyhose, and shoes), aggressive manicures, the use of artificial nails, hangnails or ingrown nails, or nail biting. Treatment may also help prevent the infection from spreading to nearby tissue. 7. Paronychia typically begins with a few days of pain, tenderness, and swelling of the finger followed by a collection of pus under the surface of the skin and/or nail. Daniel CR 3d, Infections of the fingertip. The doctor may have made a small cut in the infected area to drain the pus. Damage done by uncontrolled infection may be severe. Paronychias and felons. either classify as bacterial or fungal infection that infect the fingernails and toenails Members of various medical faculties develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family Medicine at the University of Michigan Medical School, Ann Arbor. You may also need surgery to drain pus or remove your nail and the tissue around it. Available for Android and iOS devices. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Chronic paronychia is often caused by multiple factors, and is usually a reaction to allergens or to persistent irritants. Include the amounts, and when and why you take them. 1990;19:994–6. Bring your own nail tools when having your fingernails or toenails cared for in nail salons. ! Eventually, the nail plates become thickened and discolored, with pronounced transverse ridges.6,8 The cuticles and nail folds may separate from the nail plate, forming a space for various microbes, especially Candida albicans, to invade.8 A wet mount with potassium hydroxide from a scraping may show hyphae, or a culture of the purulent discharge may show hyphae for bacteria and fungal elements. Warm-water soaks four times a day for 15 minutes should be performed to keep the wound open. Paronychia is one of the most common infections of the hand. Nail infections. For acute paronychia, soaking the area in warm water a few times a day usually does the trick. Paronychia is an infection of the skin around the nail of at least one finger or toe. It happens when germs enter through a break in the skin. Hochman LG. Dr. Rockwell also serves as the medical director of the Family Practice Clinic at East Ann Arbor Health Center in Ann Arbor, which is affiliated with the University of Michigan Medical School. Jebson PJ. Be sure to take all of the antibiotics I prescribe for you and keep doing the hot soaks for about 2 days after you think it is much better. 3. It is not intended as medical advice for individual conditions or treatments. Most cases of paronychia improve in a few days. 11 scalpel should be gently placed on top of the nail with the point of the blade directed toward the center of the abscess. Excellent job! Microbiology and management. Guest editor of the series is Barbara S. Apgar, M.D., M.S., who is also an associate editor of AFP, Osteoporosis: Part II. Diagnosis and treatment of infectious, inflammatory, and neoplastic nail conditions. Do not wait until the pain is severe before you take your medicine. Paronychias are localized, superficial infections or abscesses of the perionychium (epidermis bordering the nails). Brook I. Hand Clin. Chronic paronychia resembles acute paronychia clinically, but the cause is multi-factorial. Clinically, paronychia presents as an acute or a chronic condition. Recurrent acute paronychia can sometimes evolve into chronic paronychia (this is often seen in patients who take poor care of their feet). After draining a finger paronychia, instruct your patient to soak their finger in warm water every two hours for the next two days. I will give you a followup appointment: please keep it, even if you think it is doing great, because I want to be sure it is healing properly. As in the treatment of any abscess, drainage is necessary. This content is owned by the AAFP. Clinically, paronychia presents as an acute or chronic (longer than six weeks' duration) condition. The perionychial area usually appears erythematous and inflamed, and the nail may appear discolored and even distorted. PAMELA G. ROCKWELL, D.O., is clinical assistant professor in the Department of Family Medicine at the University of Michigan Medical School, Ann Arbor. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. Paronychia: a mixed infection. Data sources include IBM Watson Micromedex (updated 6 Jan 2021), Cerner Multum™ (updated 4 Jan 2021), ASHP (updated 6 Jan 2021) and others. When it is necessary to wear vinyl gloves, cotton gloves should be worn underneath.3,10 Treatment with a combination of topical steroids and an antifungal agent has been shown to be successful.3,7 Oral antifungal therapy is rarely necesssary.3 Treatment of potential secondary bacterial infections with antibacterial solutions or ointments, acetic acid soaks (1:1 ratio of vinegar to water) or oral antibiotics may be necessary. Let’s start with some anatomy (hurrah!) The paronychia is recurrent. At this point, pus should slowly extrude from the abscessed cavity. Information from Jebson PJ. Ann Emerg Med. The blade should be guided slowly and gently between the nail and the eponychial (cuticle) fold so that the tip of the blade reaches the center of the most raised portion of the abscess. Kilgore ES. Sullivan S, Germs such as bacteria and fungi may enter through the torn skin, causing an infection. Gram-negative organisms, herpes simplex virus, dermatophytes and yeasts have also been reported as causative agents. This material must not be used for commercial purposes, or in any hospital or medical facility. Aerobic and anaerobic microbiology of paronychia. The blog will focus on procedures that emergency medicine residents and midlevel providers are often called on to perform in the ED. With chronic paronychia, your nail may change color or become thick. 1989;6:403–16. Treatment may consist of warm-water soaks, antimicrobial therapy or surgical intervention. For continuing care, treatments, or home services, ask for more information. It typically develops around the edges of the nail at the bottom or sides. The treatment of felons and paronychias. Doctors divide paronychia into two classes: acute and chronic paronychia. DISCHARGE INSTRUCTIONS: Medicines: Td vaccine is a booster shot used to help prevent tetanus and diphtheria. Anyone needs to see adoctor because home treatment isn’t likely to work. Wear proper footwear to keep your infected toe clean. She received a medical degree from Michigan State University College of Osteopathic Medicine in East Lansing and completed a family practice residency at Eastern Virginia Medical School in Norfolk, Va. The nail bed lies beneath the nail plate and contains the blood vessels and nerves. Noninfectious causes of paronychia include contact irritants and excessive moisture. There are a few home remedies that you can try at home to treat paronychia fast. Jules KT, You'll want to call a doctor right away if you have an abscess (a pus-filled area in the skin or under the nail) or if it looks like the infection has spread beyond the area of the nail. Roberge RJ, 63/No. Bacterial infections of fingers tend to spread rapidly along the finger. Chronic infection is most likely due to candida Keep your infected finger or toe clean and dry at all times. Penicillin and ampicillin are the most effective agents against oral bacteria. Reprints are not available from the author. Members of various medical faculties develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family Medicine at the University of Michigan Medical School, Ann Arbor. When draining it, doctor can also take a sample of pus from the wound to determine what is causing the infection and how best to treat it. The term is from Greek: παρωνυχία from para, "around", onyx, "nail" and the abstract noun suffix … Daniel CM, Roberge RJ, PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan. 1. Paronychia is an inflammation of the skin around the nail, which can occur suddenly (acute), when it is usually due to the bacteria Staph. You may need medicine to treat your pain, swelling, and infection. Paronychia may happen suddenly and last for 6 weeks or longer. Rub moisturizing lotion into your hands after washing them. Hand Clin. Choose a single article, issue, or full-access subscription. You have questions or concerns about your condition, treatment, or care. Am Fam Physician. The infection is caused by bacteria, wherein the infected skin around the nail is swollen and tender. In addition, metastatic cancer, subungual melanoma and squamous cell carcinoma may present as chronic paronychia. Bonar PL. Search for: Search. St. Louis: Mosby, 1996. 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