Paronychia 681.02

synonyms:

Paronychia ICD-9

• 681.02 Onychia and paroncychia of finger
  

Paronychia Etiology / Epidemiology / Natural History

• Definition = infection beneath the eponychial fold.
• Most common organism = Staph aureus

Paronychia Anatomy

• 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.

Paronychia Xray

• 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:
• 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 Complications

Paronychia Follow-up Care

• QD / BID soaks and dressing changes until resolution.

Paronychia References

Greens Hand Surgery