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Paronychia

Nancy V. Nguyen, DO Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Superficial inflammation of the lateral and posterior folds of skin surrounding the fingernail or toenail

    • Acute: characterized by pain, erythema, and swelling; usually a bacterial inf...

DIAGNOSIS

HISTORY

  • Localized pain or tenderness, swelling, and erythema of posterior or lateral nail folds

    • Acute: fairly rapid onset

    • Chronic: at least 6 weeks’ duration

  • Previous trauma (bitten nails, ingro...

TREATMENT

GENERAL MEASURES

  • Acute: warm compresses/soaks, elevation, splint protection if pain severe

  • Abscesses should be opened to promote drainage.

  • Insert nail elevator or hypodermic needle at junction ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Acute: Postdrainage care consists of warm soaks or soaking with Burow solution or acetic acid BID–TID for 2 to 3 days unless Swiss roll technique used (1)[C].

  • Chro...

REFERENCES

1
Leggit JC. Acute and chronic paronychia. Am Fam Physician.  2017;96(1):44–51. [View Abstract on OvidMedline]
2
Wollina U. Acute paronychia: comparative treatment with topical antibiotic...

ADDITIONAL READING

  • Chiriac A, Brzezinski P, Foia L, et al. Chloronychia: green nail syndrome caused by Pseudomonas aeruginosa in elderly persons. Clin Interv Aging.  2015;10:265–267. [View Abstra...

CODES

ICD10

  • L03.019 Cellulitis of unspecified finger

  • L03.039 Cellulitis of unspecified toe

  • L03.011 Cellulitis of right finger

  • L03.012 Cellulitis of left finger

  • L03.031 Cellulitis of right toe

  • L03.032 Cellul...

CLINICAL PEARLS

  • Consider tetanus booster when indicated.

  • Consider incision and drainage when appropriate. Send culture.

  • For chronic paronychia, topical steroid is first-line treatment. Consider other di...

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