synonyms: Onychia, paroncychia
- L03.011 Cellulitis right finger
- L03.012 Cellulitis left finger
- L03.019 Cellulitis unspecified finger
- 681.02 Onychia and paroncychia of finger
Paronychia Etiology / Epidemiology / Natural History
- Definition = infection beneath the eponychial fold.
- Most common organism = Staph aureus
- Infection can tract beneath the nail fold (superficial to the nail) or deep to the nail (between the nail and the matrix.)
Paronychia Clinical Evaluation
- Commonly associated with manicures, patients with artificial nails, nail biters, and hangnails.
- Swelling, erthema and tendernes about the nail fold.
- A/P and lateral of affected finger are usually normal.
Paronychia Classification / Treatment
- Acute: if caught very earily a short trial of oral antibiotics may be used.
- Subacute / : Incisions and drainage with oral antibiotic treatment. Dicloxacillin 500 mg PO q6h, or Nafcillin 1-2 g IV q4-6h, or Clindamycin 300 mg PO q6h Cephalexin 500 mg PO q6h, or Cefazolin 1 g IV q8h, or Erythromycin 500 mg PO q6h
- MRSA is becoming increaseingly prevalent, especially in hand infections. Consider Bactrim DS +/- rifampin. If group A streptococcus is strongly suspected add Keflex
- Chronic infections which fail to respond to appropriate treatment may involve fungi or atypical mycobacteria. Consider infectious disease consult. If atypical mycobacteria are suspected, Ziehl-Neelsen staining and cultures at 28°C to 32°C in Löwenstein-Jensen medium should be performed. Fungi evaluation is done with a potassium hydroxide preparation.
Infections associated with intravenous (IV) drug use, bite wounds,and mutilating farm injuries and those associated with diabetes mellitus often are polymicrobial, involving
Gram-positive, Gram-negative,and anaerobic species.1-7
Paronychia Incision and Drainage Technique
- Digital block
- Prep and drap in standard sterile fashion
- Elevate the nail fold witha Freer elevator or fine hemostat evacuating the purulent material.
- The nail is held open with a small piece of gauze.
- If the infection has spread beneath the nail, the nail is elevated off its matrix and a portion, or all of the nail is removed.
Paronychia Associated Injuries / Differential Diagnosis
Paronychia Follow-up Care
- QD / BID soaks and dressing changes until resolution.