Paronychia symptoms - Paronychia treatment

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Paronychia signs and symptoms

Paronychia affected nail fold may present reddening (erythema), tenderness, pain and edema (swelling). Acute paronychia may manifesting over hours to days.
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Pus may develop along the nail margin. In severe acute conditions pus is also formed below the nail plate.

In case of chronic condition the cuticle and proximal nail fold may get retracted and separated from the nail plate. The paronychia infection may spread into deeper tissues of pulp space in the palm side of the finger causing felon which requires aggressive treatment. Severe acute infection can cause chills and fever.

In patients with acute form of paronychia, typically only one nail is involved. In chronic form, usually the thumb and second or third fingers of the dominant hand are involved. The diagnosis is usually by visual observations. Chronic or acute conditions not responding to treatment may require differential diagnosis to rule out squamous cell carcinoma, malignant tumors, eczema and psoriasis.
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Herpetic whitlow must be ruled out as the treatments are drastically different and mistreatment may do more harm than good.

Paronychia treatment

Nail fold infection, especially the chronic form, is prevalent in laundry workers, agricultural laborers, food handlers, dishwashers, fishermen, fishmongers, fish farm workers, dairy workers, watersports personals and swimmers. Treatment of paronychia is determined by the degree of inflammation and infection and also whether it is acute or chronic.

Warm water soak treatment for paronychia

Mild, acute cases of paronychia without abscess only require soaking the affected finger or toe in warm water to which antibacterial soap/epsom salt/vinegar is added. At a time about 15-20 minutes of soaking is required and it may be repeated four or five times a day. The warm water increases the circulation to the soaked area, inducing the immune cells to do their job of clearing the infection. The added ingredients will function as mild antibiotic.

Topical applications

treatment is typically different from acute treatment.For acute nail fold infection where there appears to be only cellulitis, topical application of antibacterial preparations may be applied apart from warm water soaking to totally remove the infection. If chronic infection with cellulitis is seen antifungal preparations and also steroids may be applied. A combination of antifungal and steroid had been found to be very effective.

Oral antibiotics

with abscess and pus formation requires apart from draining the pus, use of oral antibacterial like clindamycin, cefadroxil or amoxicillin to clear the infection. Chronic fungal paronychia may require a long course of systemic antifungal medication. There is always a possibility a concurrent bacterial infection requiring the use of antibacterial medication.
Image of paronychia
Paronychia of finger

Surgical intervention in paronychia

Abscess formation and pus collection in acute paronychia requires surgical intervention to drain the pus. This may be done in several different ways. Normally the cuticle at the abscess is raised making passage for the pus to drain out. If neglected, acute or chronic condition may worsen affecting the deeper tissues it may cause ascending lymphangitis or sepsis.

In cases of paronychia where the abscess is further away from the cuticle, a small incision can be made directly over the abscess to drain the pus followed by eponychial marsupialization. The procedure is usually pain free and in exceptional cases local anesthetic can be used. The wound may be packed for two days with a piece of plain gauze packing soaked in antibiotic cream. After removal of the packing, the patient may be advised warm water soak treatment till the acute reddening and inflammation subsides.

In chronic paronychia where the nail plate and nail bed are damaged partial or total removal of the nail become necessary. This procedure is usually done under local anesthesia and the wound will take several days to heal. The patient should also try to find and avoid the root cause of the chronic condition whenever possible, or chronic paronychia may recur.
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References on paronychia:
1.Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.
2.Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar;22(3):165-74.
3.Duhard É. Paronychia. Presse Med. 2014 Nov;43(11):1216-22.
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