Dermatologic Manifestations of Paronychia Workup

  • Author: Allison Vidimos, MD, RPh; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 10, 2010
 

Laboratory Studies

Fluctuant paronychia is usually caused by bacteria; therefore, routine Gram staining helps in identifying the organism.

Potassium hydroxide 5% smears may be helpful in diagnosing fluctuant paronychia if Gram staining results are negative or if candidal infection is suspected, as in chronic paronychia. If Gram staining results are positive, the KOH preparation may demonstrate pseudomycelia and clusters of grapelike yeast cells. KOH wet mounts from scrapings or discharge may show hyphae.

Tzanck smears may be performed if herpetic whitlow is suspected. Smears should be performed by using base scrapings of an unroofed vesicle. The presence of multinucleated giant cells, often with visible viral inclusions, indicates a positive result.

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Imaging Studies

No radiologic studies are required. The diagnosis is primarily based on the features of the history and on the physical examination findings.

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Contributor Information and Disclosures
Author

Allison Vidimos, MD, RPh  Staff, Section of Micrographic Surgery (Mohs) and Oncology; Chairman, Department of Dermatology; Cleveland Clinic

Allison Vidimos, MD, RPh is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth M Billingsley, MD  Professor of Dermatology, Penn State University College of Medicine; Director, Dermatologic Surgery and Mohs Micrographic Surgery, Penn State Hersey Medical Center

Elizabeth M Billingsley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, Association of Professors of Dermatology, Council for Nail Disorders, and Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard K Scher, MD  Professor of Dermatology, University of North Carolina

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Cryosurgery, American College of Physicians, American Dermatological Association, American Geriatrics Society, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, New York Academy of Sciences, Noah Worcester Dermatological Society, Rhode Island Medical Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Julia R Nunley, MD  Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society

Disclosure: Novartis Grant/research funds Consulting; Biolex Grant/research funds sub-investigator

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Depicted are the nail fold (A), dorsal roof (B), ventral floor (C), nail wall (D), perionychium (E), lunula (F), nail bed (G), germinal matrix (H), sterile matrix (I), nail plate (J), hyponychium (K), distal groove (L), fascial septa (M), fat pad (N), distal interphalangeal joint (O), and extensor tendon insertion (P).
Typical appearance of paronychia.
Simple acute paronychia can be drained by elevating the eponychial fold from the nail with a small blunt instrument such as a metal probe or elevator.
 
 
 
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