Paronychia


Paronychia is a soft-tissue infection along the border of the fingernail or paronychium that results from the breakdown of the skin and entry of bacteria or fungi into the nail fold.

SYMPTOMS/EXAM

DIFFERENTIAL

DIAGNOSIS

TREATMENT

Felon/
paronychia
TMP/SMX double strength, 1-2 tablets BID PO for 7-10 d. S. aureus (MRSA), S. pyogenes, anaerobes, polymicrobial Antibiotics indicated for infections with associated localized cellulitis, otherwise drainage alone may be sufficient, culture recommended by hand surgeons.
 
Plus/minus cephalexin, 500 mg PO QID for 7–10 d, or dicloxacillin, 500 mg PO QID for 7-10 d.
Consider addition of clindamycin or amoxicillin-clavulanate to TMP/SMX (rather than cephalexin) if anaerobic bacteria are suspected.

COMPLICATIONS