MANUAL MINORS
Paronychia is an infection of the periungual tissue surrounding the nail, caused by bacteria such as Staphylococcus aureus, or by fungi in chronic infections. It can present as either acute or chronic, with the former being more common following minor trauma, such as nail-biting, manicures, or cuts. The infection leads to pain, redness, and swelling around the nail, and in severe cases, pus accumulation.
Diagnosis
The diagnosis is clinical, based on the observation of pain, swelling, redness, and possible pus collection around the nail. In chronic cases, the periungual skin appears thickened and may be more elevated. Microbiological tests may be performed if fungal infection is suspected.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Felon | Deep infection of the fingertip pad with pus accumulation. |
Herpetic Whitlow | Painful vesicles in the periungual area, without abscess formation. |
Cellulitis | More extensive infection of the subcutaneous tissue, not limited to the periungual area. |
Ingrown Toenail (Onychocryptosis) | Pain and swelling on one side of the nail due to its penetration into the soft tissue. |
Emergency Management
In acute paronychia, initial treatment includes warm water soaks with antiseptic (such as povidone-iodine) to reduce inflammation.If pus is present, incision and drainage of the purulent collection is performed under sterile conditions.For mild infections, topical antibiotics are prescribed, while for more severe infections or those with accompanying cellulitis, oral antibiotics (such as cephalexin or clindamycin) are administered. In chronic paronychia, topical or systemic antifungals are recommended if fungal infection is confirmed.
Definitive Treatment
Acute paronychia typically resolves with drainage and appropriate antibiotic treatment. Avoiding triggers, such as nail-biting or aggressive manicures, is important. In chronic cases, treatment focuses on eliminating the irritant, as well as using antifungals for recurrent infections. In severe cases where the infection affects the nail bed or recurs, partial or total nail resection may be necessary.
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