Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Paronychia 1139

PARONYCHIA

JEFFREY P. CALLEN, MD

history & physical

History

■Inflammation around the periungual structures (nail fold)

■May be due to bacteria (acute) or candida (chronic) or a combination

of bacteria and yeast

■Excessive moisture may predispose – e.g., bartenders, healthcare

workers, children who suck their fingers

■Trauma may be involved

Signs & Symptoms

■Inflammation characterized by erythema, tenderness, swelling and

occasional discharge of pus in a periungual location

■May result in disturbance of the nail growth with eventual ridging

tests

■Basic tests: none needed

■Basic Tests: none needed

■Specific Diagnostic Tests

➣culture for bacteria

➣fungal culture

➣Tzanck smear or viral culture if herpes simplex is considered

■Imaging studies

➣Radiographs for recurrent or non-responsive disease to rule out

osteomyelitis

differential diagnosis

■The process is clinically characteristic; the main differential diagno-

sis is among the infecting organism.

■Herpetic whitlow may be considered a viral form of paronychia.

■Eczema

management

What to Do First

■Assess the risk factors such as trauma, exposure to excess moisture.

General Measures

■Keep area dry.

■Avoid manipulation of the cuticle.