Paronychia in Emergency Medicine Follow-up

  • Author: Heather Murphy-Lavoie, MD, FAAEM; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Oct 20, 2010
 

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.
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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.
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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.
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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.
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Prognosis

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

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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; 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.

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.

References

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Paronychia incision and drainage.
Paronychial erythema and edema with associated pustule. This suggests a bacterial etiology.
Paronychia, side view.
After simple drainage, there is purulent return.
 
 
 
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