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Paronychia L03.019 681.02

 

synonyms: Onychia,  paroncychia

Paronychia ICD-10

  • L03.011 Cellulitis right finger
  • L03.012 Cellulitis left finger
  • L03.019 Cellulitis 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