eMedicine Specialties > Clinical Procedures > Soft Tissue Procedures

Hand, Paronychia Drainage

Author: Noah Elise Gudel, DO, Resident in Internal Medicine, University of Tennessee Medical Center at Knoxville
Coauthor(s): Mohamad Marouf, MD, Consulting Staff, Department of Emergency Medicine, University Hospitals Health System, Richmond Heights Medical Center
Contributor Information and Disclosures

Updated: Jul 29, 2008

Introduction

A paronychia is a soft tissue infection that is localized to the proximal and/or lateral nail fold,1 though it may also spread to the surrounding subcutaneous tissue or under the entire nail. It begins as a cellulitis but may progress to a definite abscess.2 It may be either acute or subacute. As subacute paronychias never require surgical intervention, further discussion here is unwarranted.


Classic presentation of a paronychia, with erythe...

Classic presentation of a paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed.

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Classic presentation of a paronychia, with erythe...

Classic presentation of a paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed.


This more lateral view shows that no pus or fluct...

This more lateral view shows that no pus or fluctuance is involved in the nail bed itself.

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This more lateral view shows that no pus or fluct...

This more lateral view shows that no pus or fluctuance is involved in the nail bed itself.


Acute paronychias are the most common infection of the hand, and they affect males and females equally. They most often occur in children and are usually limited to one finger (most often the thumb).3 Poor hygiene and trauma to the proximal or lateral nail fold, such as that from hangnails, nail biting, or thumb-sucking, can cause an acute paronychia, which presents as an erythematous painful swelling around the nail fold.

The most common pathogen in adults is Staphylococcus aureus (though Streptococcus pyogenes, Enterococcus faecalis, and Proteus and Pseudomonas species can also be involved),3 and infections in children are often due to mixed oropharyngeal flora (due to thumb-sucking and fingernail biting).4 Click here to complete a Medscape CME activity on the examination of fingernails in elderly patients.

If soft tissue swelling is present without fluctuance, the infection may resolve with warm soaks 3-4 times daily and a short course of antistaphylococcal antibiotics.4,5 Once any sign of abscess formation appears, such as fluctuance or visible pus, surgical intervention is indicated.6

The definitive treatment for an acute paronychia is drainage. Though antibiotics are commonly prescribed2 , most patients do not require antibiotics for a simple paronychia. Those with extensive surrounding cellulitis or with a history of diabetes, peripheral vascular disease, or immunocompromised state may benefit from a short course of antibiotics. An antistaphylococcal penicillin or first-generation cephalosporin is generally effective. Clindamycin and amoxicillin-clavulanate are also appropriate.5,7 Wound cultures are not generally necessary in minor nonrecurrent infection. Tetanus status should be assessed, and a booster given, if appropriate.7

Indications

  • Indication of abscess formation, such as fluctuance
  • Nail bed mobility (indicates that the infection has extended under the nail)

Contraindications

  • No absolute contraindications exist.

More on Hand, Paronychia Drainage

Overview: Hand, Paronychia Drainage
Treatment & Medication: Hand, Paronychia Drainage
Multimedia: Hand, Paronychia Drainage
References
Further Reading
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References

  1. Office surgery. In: Rakel R, ed. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders Company; 2002:663.

  2. Hand. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 5th ed. St. Louis, Mo: Mosby; 2002:529-30.

  3. Opal S, Petropoulos P, Mikolich D, Ferri F. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, Pa: Mosby; 2008:667.

  4. Roberts JR, Hedges JR. Incision and drainage. In: Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: WB Saunders Company; 2004:738-41.

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

  6. Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:1167-68.

  7. Clark DC. Common acute hand infections. Am Fam Physician. Dec 1 2003;68(11):2167-76. [Medline]. [Full Text].

  8. Hand infections. In: Canale ST, ed. Campbell's Operative Orthopaedics. Vol 4. 10th ed. Philadelphia, Pa: Mosby; 2003:3810-13.

  9. Halstead Residents of the Johns Hopkins Hospital. Chen H, Sonnenday C, Lillemoe K. Manual of Common Bedside Surgical Procedures. 2000:361.

  10. Gmyrek R. Local anesthesia and regional nerve block anesthesia. eMedicine from WebMD [serial online]. February 7, 2007;Accessed December 22, 2007. Available at www.emedicine.com/derm/topic824.htm.

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Further Reading

Griffiths G, Rocker M, Lewis MH, Gower-Thomas K. Paronychia or an abscess: early diagnosis. Hosp Med. 2004;65(11):696. 

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Keywords

paronychia drainage, drain paronychia, paronychia, paronychial infection, inflammation of nail fold, infection of the hand, finger infection, toe infection, onychia lateralis, onychia periungualis, digital nerve block, incision and drainage, I & D, felon, ingrown nail, subungual hematoma, subungual abscess, onychocryptosis, closed-space infections, fingertip pulp, hand infections, osteomyelitis, tenosynovitis, septic arthritis, infection, infection, nail bed infection, nailbed infection

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Contributor Information and Disclosures

Author

Noah Elise Gudel, DO, Resident in Internal Medicine, University of Tennessee Medical Center at Knoxville
Disclosure: Nothing to disclose.

Coauthor(s)

Mohamad Marouf, MD, Consulting Staff, Department of Emergency Medicine, University Hospitals Health System, Richmond Heights Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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