eMedicine Specialties > Emergency Medicine > Infectious Diseases

Paronychia: Follow-up

Author: Heather Murphy-Lavoie, MD, FAAEM, Assistant Professor, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine, New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine
Coauthor(s): Micelle J Haydel, MD, Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center
Contributor Information and Disclosures

Updated: Nov 23, 2009

Follow-up

Further Inpatient Care

  • Admission for paronychia is rarely required unless associated with a significant cellulitis, tendonitis, or deep space infection of the hand requiring IV antibiotics.

Further Outpatient Care

  • Warm water soaks are the mainstay of treatment. Early in the course of this disease, prior to the development of an abscess, frequent soaking may be sufficient to resolve the infection.
  • Instruct patients to leave any wick in place for 24-48 hours, depending on the depth and extent of the purulent space.
  • After removing the wick, patients can begin warm soaks 3-4 times per day and should have a follow-up examination in 48 hours after incision and drainage to assure the infection is resolving appropriately.

Deterrence/Prevention

  • Trim hangnails to a semilunar smooth edge with a clean sharp nail plate trimmer. Trim toenails flush with the toe tip. Do not bite the nail plate or lateral nail folds.
  • Avoid prolonged hand exposure to moisture. If hand washing must be frequent, use antibacterial soap, thoroughly dry hands with a clean towel, and apply an antibacterial moisturizer.
  • Wear rubber or latex-free gloves.
  • Control diabetes mellitus.

Complications

  • Paronychial infections may spread to the pulp space of the finger, developing a felon.
  • If neglected, infection may continue to spread to involve the tendons or deep spaces of the hand.
  • Secondary ridging, thickening, and discoloration of the nail may be observed.
  • Nail loss may occur.

Prognosis

  • The prognosis is usually good if treated promptly.
  • The incidence of chronic paronychia is increased among immunocompromised individuals.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to incise and drain adequately
  • Failure to have patient return for rechecks until infection is clearly resolving
  • Failure to place a wick to hold open abscess cavity during first 24 h
  • Failure to remove lateral nail if a subungual infection is present
  • Failure to diagnose herpetic whitlow, trauma such as incision may worsen the course of this disease process
  • Unnecessary treatment with antibiotics

Special Concerns

  • Paronychia has been known to initiate from malignant lesions. Any history of prior malignancy or a pigmented irregular appearance of surrounding tissue should result in appropriate suspicion and referral for biopsy.
  • Painless swelling lateral to the nail plate in a patient with osteoarthritis should prompt investigation for mucous cyst.
  • Constant severe pain with nail plate elevation, bluish discoloration of the nail plate, and blurring of the lunula suggest the presence of a glomus tumor.
 


More on Paronychia

Overview: Paronychia
Differential Diagnoses & Workup: Paronychia
Treatment & Medication: Paronychia
Follow-up: Paronychia
Multimedia: Paronychia
References
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References

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  2. Chronic paronychia: what you should know. Am Fam Physician. Feb 1 2008;77(3):347-8. [Medline].

  3. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. Mar 15 2001;63(6):1113-6. [Medline].

  4. Canales FL, Newmeyer WL 3rd, Kilgore ES Jr. The treatment of felons and paronychias. Hand Clin. Nov 1989;5(4):515-23. [Medline].

  5. Dahdah MJ, Scher RK. Nail diseases related to nail cosmetics. Dermatol Clin. Apr 2006;24(2):233-9, vii. [Medline].

  6. Colson AE, Sax PE, Keller MJ, et al. Paronychia in association with indinavir treatment. Clin Infect Dis. Jan 2001;32(1):140-3. [Medline].

  7. Hijjawi JB, Dennison DG. Acute felon as a complication of systemic Paclitaxel therapy: case report and review of the literature. Hand. Sep 2007;2(3):101-3. [Medline].

  8. Kapellen TM, Galler A, Kiess W. Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes mellitus than in non-diabetic peers. J Pediatr Endocrinol Metab. Jun 2003;16(5):751-8. [Medline].

  9. Tosti A, Piraccini BM, D'Antuono A, et al. Paronychia associated with antiretroviral therapy. Br J Dermatol. Jun 1999;140(6):1165-8. [Medline].

  10. Yip KM, Lam SL, Shee BW, et al. Subungual squamous cell carcinoma: report of 2 cases. J Formos Med Assoc. Aug 2000;99(8):646-9. [Medline].

  11. Daniel CR 3rd. Paronychia. Dermatol Clin. Jul 1985;3(3):461-4. [Medline].

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  13. Muñiz AE, Evans T. Chronic paronychia, osteomyelitis, and paravertebral abscess in a child with blastomycosis. J Emerg Med. Oct 2000;19(3):245-8. [Medline].

  14. Turkmen A, Warner RM, Page RE. Digital pressure test for paronychia. Br J Plast Surg. Jan 2004;57(1):93-4. [Medline].

  15. Riesbeck K. Paronychia due to Prevotella bivia that resulted in amputation: fast and correct bacteriological diagnosis is crucial. J Clin Microbiol. Oct 2003;41(10):4901-3. [Medline].

  16. Daniel CR 3rd, Daniel MP, Daniel J, et al. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis. Jan 2004;73(1):81-5. [Medline].

  17. Engineer L, Norton LA, Ahmed AR. Nail involvement in pemphigus vulgaris. J Am Acad Dermatol. Sep 2000;43(3):529-35. [Medline].

  18. Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin. Nov 1998;14(4):547-55, viii. [Medline].

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Further Reading

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Keywords

paronychia, finger infection, paronychia symptoms, paronychia treatment, paronychial infection, onychia lateralis, onychia periungualis, inflammation of the nail fold, incision and drainage, nail infection, superficial infection of the epithelium, eponychia, felon, runaround abscess, herpetic whitlow, chronic paronychia, acute paronychia

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Contributor Information and Disclosures

Author

Heather Murphy-Lavoie, MD, FAAEM, Assistant Professor, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine, New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine
Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Micelle J Haydel, MD, Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center
Micelle J Haydel, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Sigma Theta Tau International, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jerome FX Naradzay, MD, FACEP, Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina
Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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