Paronychia

An acute paronychia is caused by a bacterial infection of the lateral or proximal nail folds after minimal to significant trauma, whereas a chronic paronychia results from an inflammatory condition caused by repetitive irritant contact exposure. Acute paronychia can be treated conservatively with warm soaks, gentle compression, topical steroid creams, and topical or oral antibiotics (Rigopoulos et al., 2008). Chronic paronychias respond to removal of the offending agent or treatment of the underlying condition or inflammatory cause.

When the local cellulitis of an acute paronychia develops into an abscess, drainage is indicated. If the fluctuant pocket of the abscess is superficial and underlying the cuticle or nail fold, a 23-gauge needle or #11 blade tip can be used to lift the edge of the fold and allow drainage without local anesthesia. A digital nerve block can be performed if the infection is deeper and requires more extensive drainage or for patient comfort. Once anesthetized, an incision can be placed parallel to the nail fold with a stab incision using a #11 bladed into the abscess with subsequent drainage and exploration to break up loculations as needed. Warm soaks should follow with oral antibiotics for the cellulitis (Fig. 28-15).

incision should be large enough to include all fluctuant areas and no more.

(From Chavez MC, Maker VK. Office surgery. In Rakel RE. Textbook of Family Medicine, 7th ed. Saunders-Flsevler, Philadelphia, 2007.)

incision should be large enough to include all fluctuant areas and no more.

(From Chavez MC, Maker VK. Office surgery. In Rakel RE. Textbook of Family Medicine, 7th ed. Saunders-Flsevler, Philadelphia, 2007.)

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