A paronychia is an infection or abscess of the tissues around
the base and along the sides of the nail plate. It is the most common
infection in the hand.1 A paronychia can be located on
the fingers or the toes. It occurs in all age groups. It can cause significant
pain and discomfort leading to a visit to the Emergency Department.
A paronychia initially presents with redness, swelling, and tenderness
along the edges of the nail plate. This can progress to an abscess
that requires drainage. An infection that extends to the overlying
proximal cuticle is termed an eponychia. In this chapter, we will
discuss different treatments that vary with the extent of the infection.
The dorsal aspect of the distal digit consists of the nail plate,
the nail bed (matrix), and the perionychium (Figure 90-1). The nail
bed is situated beneath the nail plate and is responsible for growth
of the nail. The perionychium consists of the soft tissue surrounding
the nail plate (eponychium and lateral nail folds).
The distal finger illustrating a paronychia and the
A paronychia is usually the result of frequent trauma, aggressive
manicures, hangnails, or nail biting.2 A disruption of
the seal between the nail plate and nail fold allows bacteria to
enter, leading to pus formation in the eponychial space (Figure
90-1). It begins as a swelling and erythema in the dorsolateral
corner of the nail fold that can progress to an abscess. The most
common organism to cause a paronychia is Staphylococcus
aureus.3 In children, paronychia are often caused
by anaerobes secondary to finger sucking or nail biting.4 Gram-negative
organisms should be considered in immunocompromised hosts. Chronic
paronychia are usually caused by Candida
An early paronychia with signs of cellulitis may be treated nonsurgically
with frequent warm soaks, immobilization, elevation, oral antibiotics,
and follow-up in 24 hours.2,6 A progression of
the infection results in fluctuance and the formation of an abscess.
The presence of an abscess, fluctuance, or pus beneath the nail
plate requires an incision and drainage procedure.
A herpetic whitlow is a herpes simplex virus infection of the
distal phalanx that can be confused with an early paronychia or
felon. The presence of multiple clear vesicles that coalesce suggests
a herpetic whitlow. The herpetic whitlow is a nonsurgical and self-limited
infection. Treatment consists of a dry dressing to the affected
finger in order to prevent autoinoculation and transmission of the
infection, oral antiviral agents, and analgesics. Incision and drainage
is not recommended, will prolong the recovery, and lead to secondary
bacterial infection.7 A chronic paronychia should be referred
to a Hand Surgeon or Dermatologist for treatment.
- Povidone iodine
- Sterile gloves
- # 11 scalpel ...
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