You are here

Paronychia L03.019 681.02

 

synonyms:

Paronychia ICD-10

  • L03.019:    Cellulitis of unspecified finger

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

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer