++
Paronychia is the most common hand infection and is characterized by inflammation and pus accumulation along a lateral nail fold. It may spread to involve the eponychium at the base of the nail and the opposite nail fold if untreated. S aureus is most frequently isolated, although the infection is generally mixed flora. Felon, dactylitis, herpetic whitlow, hydrofluoric acid burn, and traumatic injury should be considered in the differential.
+++
Management and Disposition
++
If paronychia is recognized early, prior to frank abscess formation, warm soaks with or without oral antibiotics may be sufficient. After 2 to 3 days, there may be enough pus accumulation along the eponychial fold to warrant incision and drainage. After digital block, a #11 blade or 18-gauge needle is advanced parallel to the nail and under the eponychium at the site of maximal fluctuance. If pus has collected under the nail (subungual abscess), then a portion must be removed to provide drainage. Oral antibiotics should be prescribed; the patient should be reevaluated in 2 to 3 days.
++
++
Paronychia is associated with nail biting, manicure trauma, and foreign bodies.
Germinal matrix damage during nail plate excision may result in nail deformity.
It is important to distinguish a paronychia from herpetic whitlow, where incision and drainage is contraindicated.
++++