Paronychia

5 Paronychia

Sam Moghtaderi and Kevin D. Plancher

History and Clinical Presentation

A 34-year-old, right hand dominant woman presented to her physician complaining of a red, tender area surrounding the nail of the third finger of her right hand. She had received a manicure 3 days prior to the onset of symptoms.

Physical Examination

The periungual areas of the affected digit appeared erythematous and swollen, and were tender to palpation over the radial paronychial fold and the eponychium (Fig. 5–1). There was also elevation of the proximal nail bed with pus extruding from below.

Diagnostic Studies

The diagnosis of paronychia is generally clinical, and does not require any diagnostic studies.

PITFALLS

Must differentiate from herpetic infections, for which incision and drainage (I&D) is typically contraindicated
In making incisions, care must be taken to avoid damage to nail matrix
Nonsurgical treatments typically not effective for chronic paronychia

PEARLS

Paronychia is the most commonly seen infection of the hand
Warm soaks and antibiotics effective if there is no drainage or fluctuance
Eponychial marsupialization for chronic paronychia; also remove nail if signs of involvement

Differential Diagnosis

Herpetic whitlow

Acute paronychia

Chronic paronychia

Diagnosis

This patient’s presentation is typical of acute paronychia, an infection of the soft tissue folds surrounding the fingernail. The clinical presentation initially consists of localized tenderness of the paronychial region, with subsequent erythema, swelling, and fluctuance (Fig. 5–2). Frank drainage and elevation of the nail plate are also seen.