0071643192.pdf

ORTHOPEDICS

■ Culture if MRSA prevalent in the area.

■ Antibiotics to cover MRSA and Eikenella corrodensif patient is immuno-

suppressed

COMPLICATIONS

Osteomyelitis, tenosynovitis, septic joint

Paronychia

Paronychia is a soft-tissue infection along the border of the fingernail or

paronychium that results from the breakdown of the skin and entry of bacteria

or fungi into the nail fold.

■ Most common hand infection

■ Acute: Caused by minor trauma and infiltration mainly by S. aureus.Strep-

tococcus,Pseudomonas, and anaerobic and Gram-negative species are other

possible causes.

■ Chronic: Primarily caused by Candida albicans. Patients often have a history

of chronically moist hands, eg, bartenders, housekeepers, marine workers.

Indinavir treatment is the most frequent cause of chronic paronychia in HIV

patients.

SYMPTOMS/EXAM

■ Acute: Swollen, tender, erythematous lateral nail fold usually after minor

trauma, most commonly nail biting

■ Chronic: Symptoms >6 weeks. It can be episodic. There is usually no

fluctuance. Patient may have thickened and discolored nail plates. Patients

often have a history of working with chemicals in moist environments with

hands, eg, bartenders, housekeepers, marine workers.

DIFFERENTIAL

Herpetic whitlow(clear vesicles on an erythematous base), skin cancers,

warts, chancres, granulomas

DIAGNOSIS

■ Clinical diagnosis of acute paronychia is sufficient.

■ KOH prep may be helpful to distinguish chronic cases caused by C. albicans.

■ Tzanck smear or viral culture if herpetic whitlow suspected

TREATMENT

■ Acute: If early, warm soaks and antibiotics may suffice. If an abscess has

developed, drainage can usually be accomplished by elevating the

paronychium with a blunt instrument. More advanced abscesses must

be incised with a No. 11 blade and drained. Occasionally, a portion of

the nail plate must be removed. Antibiotics are indicated for 5–7 days to

cover Gram-positive organisms.

■ Chronic:

■ Avoid water and irritating substances; topical antifungals for persistent

cases.

■ Do not incise the lesion if herpetic whitlow is suspected.