Paronychia – StatPearls – NCBI Bookshelf

Continuing Education Activity

Paronychia is an infection of the proximal and lateral toenail and fingernail folds which may occur spontaneously or following trauma or manipulation. It is one of the most common infections of the hand, and it is essential to know how to treat it appropriately. This activity reviews the cause, presentation, and pathophysiology of paronychia and highlights the role of the interprofessional team in its management.

Objectives:

• Identify the etiology and pathophysiology of paronychia.

• Review the appropriate examination and evaluation of paronychia.

• Describe the appropriate treatment and management of paronychia.

• Summarize interprofessional team strategies for improving care coordination and communication to treat paronychia successfully and improve patient outcomes.

Access free multiple choice questions on this topic.

Introduction

Paronychia is an infection of the proximal and lateral fingernails and toenails folds, including the tissue that borders the root and sides of the nail. This condition can occur spontaneously or following trauma or manipulation. Paronychia is among the most common infections of the hand. Paronychia results from the disruption of the protective barrier between the nail and the nail fold, introducing bacteria and predisposing the area to infection. Acute paronychia is usually limited to one nail; however, if drug-induced, it can involve many nails.[1][2]

Etiology

The classification of paronychia is according to the clinical presentation:

• Acute paronychia – Lasting less than six weeks, painful and purulent condition; most frequently caused by a bacterial infection, especially staphylococci.

• Chronic paronychia – Usually caused by mechanical or chemical factors and sometimes infectious etiology like a fungal infection, especially Candida species. Risk factors include occupation (dishwasher, bartender, housekeeper), certain medications, and immunosuppression (diabetes, HIV, malignancy).

Classification can also be by etiology:

• Bacterial, commonly staphylococci

• Viral, commonly Herpes simplex virus

• Fungal, commonly Candida species

Noninfectious causes of paronychia can include contact irritants, excessive moisture, and medication reaction.[3]

Epidemiology

Paronychia is more common in women than in men, with a female-to-male ratio of 3 to 1. Usually, they affect manual labor workers or patients in occupations that require them to have their hands or feet submerged in water for prolonged periods (e.g., dishwashers). Middle-aged females are at the highest risk of infection.[4]

Pathophysiology

Paronychia results from the disruption of the protective barrier between the nail and the nail fold, which is the cuticle. Trauma (including manicures and pedicures), infections (including bacterial, viral, and fungal), structural abnormalities, and inflammatory diseases (ex. psoriasis) are predisposing factors. Organisms will enter the moist nail crevice, which leads to colonization of the area. The majority of acute paronychias are due to trauma, nail-biting, aggressive manicuring, artificial nails, and may involve a retained foreign body. Infections are most commonly the result of Staphylococcus aureus. Streptococci and Pseudomonas are more common in chronic infections. [5] Less common causative agents include gram-negative organisms, dermatophytes, herpes simplex virus, and yeast. Children are prone to acute infection due to habitual nail-biting and finger sucking, leading to direct inoculation of oral flora, which would include both aerobic bacteria (S. aureus, streptococci, Eikenella corrodens) and anaerobic bacteria (Fusobacterium, Peptostreptococcus, Prevotella, Porphyromonas spp.).[6]

History and Physical

Paronychia is most commonly an acute inflammatory process causing painful redness and swelling to the lateral nail fold and is primarily diagnosed based on clinical presentation. The patient will usually present within the first few days of infection due to the pain. History may include recent trauma, infection, structural abnormalities, or inflammatory diseases. Occupation and working environment are critical historical findings; homemakers, bartenders, and dishwashers seem predisposed to developing chronic paronychia. Past medical history inquiry should include any debilitating illness like diabetes and HIV.[7] A list of medications the patient is currently taking may help determine the cause of chronic paronychia.[8]

Physical exam for acute paronychia will reveal an erythematous, swollen, and tender lateral nail fold. If an abscess is present, there may be an area of fluctuance. If there is an uncertainty of an abscess present, a digital pressure test may prove useful; the examiner can do this by applying pressure to the volar aspect of the involved digit. If an abscess is present, a larger than expected area of blanching will be visible at the paronychia and drainage will be needed. In chronic paronychia, the nail fold may be red and swollen, but fluctuance is rare. The nail fold may appear boggy, and the nail plate can become thickened and discolored. Other common findings of chronic paronychia may be a retraction of the proximal nail fold, nail dystrophy, and loss of the cuticle.[3]

Evaluation

To diagnose a paronychia, you will need to obtain a good history and physical, revealing a swollen and tender nail fold, as there is no laboratory testing or imaging that will lead to the diagnosis. The infection is usually straightforward; however, the presence of an abscess is not always evident, and the digital pressure test described above can be used to guide you. 

Treatment / Management

Paronychias are usually either treated with incision and drainage or antibiotics. If there is inflammation with no definite abscess, treatment can include warm soaks with water or antiseptic solutions (chlorhexidine, povidone-iodine) and antibiotics. Warm soaks should be for 10 to 15 minutes, multiple times a day. There is not strong evidence recommending topical vs. oral antibiotics, and this may be physician-dependent based on experience. Antibiotic used should have staph aureus coverage. Topical antibiotics used may be a triple antibiotic ointment, bacitracin, or mupirocin.  In patients failing topical treatment or more severe cases, oral antibiotics are an option; dicloxacillin (250mg four times a day) or cephalexin (500mg three to four times a day). Indications for antibiotics with anaerobic coverage include patients where there is a concern for oral inoculation; this would require the addition of clindamycin or amoxicillin-clavulanate. If the patient has risk factors for MRSA (including but not limited to: recent hospitalization, recent surgery, ESRD on hemodialysis, HIV/AIDS, IVDU, resident of long term care facility), chose an antibiotic with the appropriate coverage. Options include trimethoprim/sulfamethoxazole DS (1 to 2 tablets twice a day), clindamycin (300 to 450mg four times a day) or doxycycline (100mg twice a day). [3]

If an abscess is present, the infection will require drainage. Incision and drainage are usually with a #11 scalpel, and the blade is inserted under the eponychial fold (lateral nail fold) until pus begins to drain. Local or digital block anesthetic is generally helpful to allow comfort to ensure complete drainage. An abscess requires irrigation with normal saline, and if the abscess and incision site is large, the clinician can pack it with plain gauze for continued drainage. If the abscess extends to the nail bed or is associated with an ingrown nail, a partial nail plate removal may be needed. If an abscess is present and not drained, it can spread under the nail to the other side and result in a “run-around abscess.” This scenario may require complete removal of the nail to allow adequate drainage and treatment. Warm soaks should be initiated after incision and drainage to encourage continued drainage by keeping the wound open and prevent secondary infection. The patient should follow up with a provider in the next 24 to 48 hours to ensure drainage and to look for signs of worsening infection. Usually, incision and drainage is the adequate treatment of acute paronychia; however, if there is a significant extension of cellulitis, oral antibiotics may be prescribed as above.[9]

In chronic paronychia, the patient should be instructed to avoid trauma as to the hands as much as possible. Wearing gloves is advised for manual workers. Treatment in chronic paronychia should point toward fungal etiology. Topical and systemic antifungal agents such as itraconazole and terbinafine are options since the etiological factor in chronic type is mostly Candida species. Other inflammatory diseases of the digits like ingrown nails, psoriasis, etc. should have treatment as well. In difficult to treat chronic paronychia, other causes such as malignancy merit exploration.

Differential Diagnosis

Differential diagnosis of paronychia include:

1- Cellulitis – Cellulitis is a superficial infection and will present as erythema and swelling to the affected portion of the body with no area of fluctuance. Treatment is with oral antibiotics.

2 – Felon – A felon is a subcutaneous infection of the digital pulp space. The area becomes warm, red, tense, and very painful due to the confinement of the infection, creating pressure in the individual compartments created by the septa of the finger pad. These require excision and drainage, usually with a longitudinal incision and blunt dissection to ensure adequate drainage.

3 – Herpetic whitlow – This is a viral infection of the distal finger caused by HSV. Patients usually develop a burning, pruritic sensation before the infection erupts. A physical exam will show vesicles, vesicopustules, along with pain and erythema. It is important to not confuse this with a felon or a paronychia as incision and drainage of herpetic whitlow could result in a secondary bacterial infection and failure to heal.

4- Onychomycosis – This is a fungal infection of the nail that causes whitish-yellowish discoloration. Sometimes difficult to treat and requires oral antibiotics instead of topical.

5- Nail Psoriasis – psoriasis can also affect the fingernails and toenails. It may cause thickening of the nails with areas of pitting, ridges, irregular contour, and even raising of the nail from the nail bed.

6- Squamous cell carcinoma – Squamous cell carcinoma is mainly cancer of the skin but can also affect the nail bed. It is a rare malignant subungual tumor subject to misdiagnosis as chronic paronychia.[1][10]

Prognosis

Paronychia usually has a good prognosis. Acute paronychia usually resolves within a few days and will rarely recur in healthy individuals. Chronic paronychia may persist for several months or longer and may recur in predisposed patients. 

Complications

Acute paronychia can cause a severe infection of the hand and may spread to involve underlying tendons, which is why appropriate treatment on initial presentation is essential. This status may require evaluation and treatment by a hand surgeon as it often involves debridement, washout, or amputation, based on the severity of the infection. The major complication of chronic paronychia is nail dystrophy. It is often associated with brittle, distorted nail plates. Nail discoloration is not an uncommon complication of chronic paronychia.[11]

Consultations

A dermatologist can manage paronychia in the majority of cases, but on rare occasions where there is involvement of the deep structure and or the bones, then hand orthopedic consultation may become necessary.

Deterrence and Patient Education

Patients should keep their hands dry and warm. Recommendations include wearing gloves for any contact with water, chemicals, and irritants. Avoid nail-biting, manicuring nail folds, using nail varnish, application of false nails until complete recovery.

Pearls and Other Issues

Manicurist should stop the habit of removing cuticles from fingernails and toenails because it will create a port of entry for a variety of organisms and ultimately leads to colonization. Surgical intervention may be necessary for more severe cases. In patients with frequent recurrences, permanent nail ablation can be beneficial.

Enhancing Healthcare Team Outcomes

Assessment of any patients with a paronychia requires full, detailed history and proper physical examination. The patient history is essential, and it might give a clue for the triggering factors. Appropriate treatment is crucial as this can prevent worsening infections and complications. 

Paronychia requires an interprofessional team approach, including physicians, specialists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. [Level V] In most cases, the clinician (physician, NP, PA) will diagnose and prescribe treatment. Pharmacists can recommend antimicrobial therapy, whether fungal or bacterial and report back to the nurse or clinician if they have any concerns. Pharmacists can also check for drug-drug interactions, and let the nurse or physician know if they are present. Nurses and pharmacists can both verify patient compliance and counsel patients on their medications or the dosing/administration of the same, and report any issues back to the prescribing clinician, who can make changes to the patient’s drug regimen based on patient needs.

Figure

Acute Paronychia. Contributed by DermNetNZ

Figure

Paronychia, Chronic. Contributed by DermNetNZ

Figure

Acute paronychia. Contributed by Daifallah M. Al Aboud, M.D.

Figure

Chronic paronychia. Contributed by Daifallah M. Al Aboud, M.D.

Figure

Paronychia. Image courtesy S Bhimji MD

References

1.

Rerucha CM, Ewing JT, Oppenlander KE, Cowan WC. Acute Hand Infections. Am Fam Physician. 2019 Feb 15;99(4):228-236. [PubMed: 30763047]

2.

Sampson B, Lewis BKH. Paronychia Associated with Ledipasvir/Sofosbuvir for Hepatitis C Treatment. J Clin Aesthet Dermatol. 2019 Jan;12(1):35-37. [PMC free article: PMC6405246] [PubMed: 30881576]

3.

Leggit JC. Acute and Chronic Paronychia. Am Fam Physician. 2017 Jul 01;96(1):44-51. [PubMed: 28671378]

4.

Black JR. Paronychia. Clin Podiatr Med Surg. 1995 Apr;12(2):183-7. [PubMed: 7600493]

5.

Natsis NE, Cohen PR. Coagulase-Negative Staphylococcus Skin and Soft Tissue Infections. Am J Clin Dermatol. 2018 Oct;19(5):671-677. [PubMed: 29882122]

6.

Brook I. The role of anaerobic bacteria in cutaneous and soft tissue abscesses and infected cysts. Anaerobe. 2007 Oct-Dec;13(5-6):171-7. [PubMed: 17923425]

7.

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. 2003 Jun;16(5):751-8. [PubMed: 12880125]

8.

Goto H, Yoshikawa S, Mori K, Otsuka M, Omodaka T, Yoshimi K, Yoshida Y, Yamamoto O, Kiyohara Y. Effective treatments for paronychia caused by oncology pharmacotherapy. J Dermatol. 2016 Jun;43(6):670-3. [PubMed: 26596962]

9.

Pierrart J, Delgrande D, Mamane W, Tordjman D, Masmejean EH. Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients. Hand Surg Rehabil. 2016 Feb;35(1):40-3. [PubMed: 27117023]

10.

Patel DB, Emmanuel NB, Stevanovic MV, Matcuk GR, Gottsegen CJ, Forrester DM, White EA. Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options. Radiographics. 2014 Nov-Dec;34(7):1968-86. [PubMed: 25384296]

11.

Graat LJ, Bosma E. [A woman with a swollen finger]. Ned Tijdschr Geneeskd. 2010;154:A988. [PubMed: 20699023]

Finger infections – Knowledge @ AMBOSS

Last updated: March 15, 2021

Summary

Common finger infections include paronychia, felon, and herpetic whitlow. A paronychia is an acute or chronic soft tissue infection around the nail body. Acute infections are typically bacterial in origin and usually occur after minor trauma. Chronic paronychia infections have a multifactorial etiology, often related to repeated exposure to moist environments and/or skin irritants, and may be accompanied by secondary fungal infection. The diagnosis of paronychia is based on clinical signs of inflammation. A bacterial culture or fungal stain can confirm the causative pathogen. Treatment of acute paronychia usually involves antibiotics, while chronic paronychia is treated with topical steroids and antifungal therapy. Complications include nail dystrophy or felon.

Felon is an infection of the distal pulp space of the fingertip. While the cause is often unknown, minor trauma most commonly precedes infection. It is a clinical diagnosis based on the presence of local pain, swelling, induration, and erythema. Early stages of felon may be managed conservatively with analgesics and antibiotics. Later stages require incision and drainage. Complications include fingertip soft tissue necrosis and osteomyelitis.

Herpetic whitlow is discussed in herpes simplex virus infections.

Paronychia

Felon

Blistering distal dactylitis

References

1. Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol. 2014; 59
   (1): p.15-20.
   doi: 10.4103/0019-5154.123482 . | Open in Read by QxMD

2. Rockwell PG. Acute and Chronic Paronychia. Am Fam Physician. 2001; 63
   (6): p.1113-1117.

3. Phillips BZ. Nail Anatomy. Nail Anatomy. New York, NY: WebMD. http://emedicine.medscape.com/article/1948841-overview. Updated: September 12, 2013. Accessed: February 28, 2017.

Hand Infections

What is a hand infection?

Hands and the structures within are especially prone to infections, whether bacterial, viral, or fungal. The anatomy of the hand is complex, and a seemingly minor injury can cause a disproportionate amount of harm. The extremities in general have a less robust blood supply than the structures of the trunk and as a result, wounds of the extremities heal slower. Those with chronic illness, such as diabetes, or those who are immunocompromised, or abuse IV drugs are even more prone to aggressive infections in the hands.

One common type of infection of the hand is a felon. A felon is an abscess of the pulp of the fingertip. The cushiony pulp of the fingertip contains multiple small spaces called septae. Infection in these spaces can cause a buildup of fluid and pressure which can potentially decrease blood supply to the fingertip with disastrous results. Rarely, a felon can lead to infection of the underlying bone.

A Herpetic Whitlow is a painful cluster of blisters on the finger related to exposure to the herpes viruses.

Pyogenic flexor tenosynovitis is an infection of the tendon sheath that surrounds the flexor tendons of the hand.

Cellulitis is an infection of the soft tissue of the skin of the hand. The hand also contains areas of open space within it where there is no muscle, tendon, or bone. These spaces can become infected and filled with pus and are known as deep space infections.

Septic arthritis infects the joints of the hand while osteomyelitis is an infection of the bones of the hand.

What causes a hand infection?

A Felon usually results from penetrating trauma to the fingertip or from an infection of the fingernail left untreated. Herpetic Whitlow is caused by exposure to one of the numerous herpes viruses. Potential methods of transmission include exposure of a health care worker to an infected patient, exposure to a sexual partner with genital herpes, or caregiver exposure to a child with gingivastomatitis, a common viral infection of early childhood whose symptoms include blisters in the mouth.

Pyogenic flexor tenosynovitis, deep space infections, septic arthritis of the hand joints, and osteomyelitis of the hand bones share common causes. They can result from hand trauma that disrupts the integrity of the skin and introduces bacteria into the hand. A superficial wound such as an ulcer or laceration can progress to cellulitis and then spread to tendons, deep spaces, joints and bones in the hand. Bacterial, viral, and fungal infections which have spread into the circulatory system from remote areas can seed the tendons, deep spaces, joints and bones of the hand with organisms that cause infection.

What are the symptoms of a hand infection?

A Felon presents with throbbing pain in the hand, redness and swelling of the fingertip, and a feeling of increased pressure in the finger pad. Herpetic whitlow begins with a prodrome of pain, itching, redness and swelling of one finger, followed by the appearance of vesicles filled with clear fluid. Pyogenic flexor tenosynovitis symptoms include fever, swelling of the hand, and pain with passive extension of the finger. Deep space infection symptoms include fever, pain, swelling, edema and sometimes fluctuance of the affected area. Septic arthritis of the hand presents with low grade fevers, pain, and decreased range of motion of the affected joint. Osteomyelitis of the hand is a serious condition and presents dramatically with high fevers, chills, severe pain. Redness, swelling, and tenderness over the tissues surrounding the affected area of the bone also occurs.

How is a hand infection diagnosed?

The diagnosis of a hand infection is often a clinical one. The symptoms described above paired with a means to introduce infection into the hand will shed light on the cause of the hand infection. Blood tests such as a CBC may show an increase in white blood cells. Another blood test, the sed rate, may be elevated. Cultures are important to determine which organism is causing the infection and to guide appropriate antimicrobial therapy. If purulent drainage is encountered, as in a felon, cellulitis, or sometimes in a deep space infection, it should be cultured. Joint aspirate can be cultured in septic arthritis, the fluid contained in a herpetic vesicle can be cultured for virus. Aspiration and culture of the synovial fluid in pyogenic flexor tenosynovitis will also be helpful.

Imaging studies are helpful in diagnosis as well. While plain film X rays can be used as a screening tool to indicate whether bony abnormalities are present, they can also point out associated conditions which complicate hand infections such as fractures and foreign bodies. MRI is a better tool for evaluation of soft tissue abscesses and deep space infection. Bone scans and CT scans are useful for osteomyelitis.

How is a hand infection treated?

Non-surgical

Treatment of a hand infection requires identification of the offending organism. Cultures are taken but require several days for definitive results. In the interim antimicrobial therapy is started based on the most likely causative organism. This may involve antibiotics, antiviral medications, or antifungal medications. The medication may be administered orally or through an IV. Once the culture results are obtained, the medication can be tailored to the specific pathogen. A Tetanus booster is also given if one has not been given in the past year. With herpetic whitlow, oral antiviral medication is prescribed to decrease the risk of recurrence and the wound is covered to prevent further transmission of the disease.

Surgical

Abscesses require incision and drainage by a hand surgeon. Deep wounds require surgical exploration. Debridement of damaged tissue and irrigation to remove purulent material is also performed. Sometimes the wound is left open for continuous irrigation before being loosely closed later.

Arthrotomy, irrigation, and debridement are used to treat septic arthritis.

In Osteomyelitis surgical debridement of the affected bone is performed. Once the infection has been cured, another surgery to reconstruct the damaged bone may be needed.

Following surgical treatment of a hand infection, the hand is placed in a splint and elevated. Physical therapy is prescribed once the infection has healed and helps the hand regain its original range of motion.

How can Dr. Knight help you with Hand infections?

Infections are among the more serious problems that can affect your hand, and it is important to have them seen and treated as soon as possible. Generally, infections will most likely be treated in an Emergency Room rather than by a specialist, but it is still important to Dr. Knight that everyone be educated about any problems they may have with their hand, should they need to seek medical attention.

We looking forward to helping you live a more pain free life. Dr. Knight is one of the top hand doctors in Dallas. Visit Dr. John Knight at our Southlake hand and wrist center or Dallas office location.

Hand Infections Fact Sheet

Frequently Asked Questions:

Is Cellulitis the same thing as an infection?
Yes. Cellulitis is the term for a specific kind of bacterial infection of the skin. Typically, it is most common on the lower body and legs, but it can also occur on the hands and arms. It is typified by red color, sensitivity to touch, and heat when touched. There can also be blistering or dimpling of the skin at and around the infection site. It is important to have cellulitis examined by a doctor as soon as possible to avoid any further development of the condition, as the responsible bacteria can multiply incredibly rapidly and spread across the skin at an alarming rate. If the cellulitis is accompanied by a fever, then the bacterial infection may have become systemic, or spread to other parts of the body, and this means that you waited too long for treatment and should see a doctor as quickly as humanly possible. While everyone carries soem risk of developing cellulitis, if you have a weakened immune system from an underlying condition or if you have an open wound, the likelihood of infection is far more likely.

What can happen to me if I get MRSA?
MRSA is the medical acronym for Methicillin Resistant Staphylococcus Aureus, and it is one of the most virulent and harmful bacteria known to medical science. Staphylococcus is a bacterium that lives naturally on our skin and on our bodies, particularly in our noses, and in a normal context, it is no more dangerous to us than any of the other thousands of bacteria that inhabit our skin. Once it enters the body itself, either through a cut or a wound or an internal injury, it can enter the blood stream or the lungs or any other organs, and cause significant damage once it gets there. Typically, staph can be treated with antibiotics with no problem, but MRSA is essentially immune to the antibiotics used to treat it, and so can run rampant while doctors search for a drug that works against it. There are many strains of MRSA, and some are more resistant than others, while some are vulnerable to other antibiotics, but it takes time to determine which kind is infecting you, and time means damage. MRSA infections often present as boils on the skin and must be drained and cleaned thoroughly to avoid further infection.

Is Paronychia very serious?
Paronychia is the infection of the skin and tissue around the fingernail or toenail, and there are two different kinds, acute and chronic. Acute is the most common, and is easily treatable, as it causes small but discrete sacs of pus to develop around the wound site. These are often the result of a hangnail or a vigorous cleaning, and so can be remedied relatively easily with careful cleaning of the wound and disinfection. Chronic paronychia is more serious, and can recur regularly. This can be cause by bacteria or fungus, and depending on the cause, can develop differently. Fungal paronychia tends to develop slowly, taking time to mature and reveal the extent of its damage to the finger. Bacterial paronychia can be very fast moving and go from mild to serious overnight.

Can I get athlete’s foot on my hand?
Athlete’s foot is called Tinea Pedis, and the ped part means foot, but there is a version called Tinea Manuum that is found on the hands. Like athlete’s foot, it is typified by an itchy rash, often accompanied with red rings (depending on the source of infection), and blisters. If left untreated, the rash may discolor the skin permanently, so early treatment is highly recommended. Often, tinea manuum is mistaken for dermatitis or psoriasis of the hands, and while they appear similar, they need to be treated differently, so it is important to ascertain which of these conditions you suffer from to properly treat it.

Animated Videos

Book an Appointment or Ask a Question

Disclaimer
HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.

Hand Infections: Background, Pathophysiology, Epidemiology

Author

Eden Kim, DO Resident Physician, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Eden Kim, DO is a member of the following medical societies: American College of Emergency Physicians, Council of Residency Directors in Emergency Medicine, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

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, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor – Chief Editor for Medscape.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Gregory S Johnston, MD Assistant Professor of Emergency Medicine, Mount Sinai Beth Israel

Disclosure: Nothing to disclose.

Rohini J Haar, MD Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center

Rohini J Haar, MD is a member of the following medical societies: Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Jordan Scaff, MD Resident Physician, Department of Emergency Medicine, Mount Sinai Beth Israel

Jordan Scaff, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Amy K Rontal, MD, and Heatherlee Bailey, MD, to the development and writing of this article.

Hand Infections Frisco, Dallas TX | Paronychia Plano

The hand becomes infected more frequently as it is one of the most commonly injured parts of our body. 

Untreated Hand Infections

Hand infections, if left untreated or treated improperly, can cause disabilities such as stiffness, contracture, weakness, and loss of tissues (skin, nerve and bone) that will persist even after the infection resolves. Therefore, prompt treatment of hand infections is important.

Common Infections of the Hand

Infections of the hand include:

Paronychia

Paronychia is an infection of the nail fold or cuticle area present around the fingernail. It may be an acute or chronic infection. 

Acute paronychia is a bacterial infection and causes pain, redness, and swelling around the nail. It is caused by superficial trauma that may occur during nail-biting or finger sucking. It can be treated with antibiotics and if pus forms, it needs to be drained. 

Chronic paronychia is a result of fungal infection and it causes milder symptoms such as mild pain, redness or swelling, with little or no pus. It occurs most commonly in people whose hands are often wet or are immunocompromised. The treatment for chronic paronychia consists of avoiding constant exposure to moisture and application of topical steroid and antifungal ointments. 

Felon

Felon is a serious infection of the fatty tissues of the fingertips and results in throbbing pain. It is caused due to direct entry of bacteria during a penetrating injury or by the spread of infection from untreated paronychia. 

If there is an abscess, surgical drainage is performed, following which antibiotics will be prescribed.

Herpetic whitlow

Herpetic whitlow is a herpes simplex virus infection of the fingers. It is more common in healthcare workers whose hands are exposed to patient’s saliva that may carry the virus. Herpetic whitlow presents as small, swollen, painful blisters. 

Conservative treatment for herpetic whitlow involves the application of a dry gauze dressing to the affected finger to avoid the spread of infection. 

Septic arthritis/osteomyelitis

Septic arthritis is a severe infection of the joint caused by a wound or draining cyst. The bacterial infection may cause destruction of the joint by eroding away the joint cartilage. 

Surgical drainage should be performed as soon as possible because the condition may get complicated if the infection spreads to the bone, causing osteomyelitis.

Deep space infections 

Deep fascial spaces are the potential spaces in between the different structures of the hand. These spaces tend to get infected through penetrating wounds or spread of infection from blood. Deep space infections may occur in the thumb, the palm or in the area between the bases of fingers. 

Treatment for deep space infections includes antibiotic therapy, pain-relieving medications and surgical drainage.

Tendon sheath infection

Tendon sheath infection is the infection of the flexor tendon, which occurs because of a small laceration or penetrating wound on the finger, near a joint. It causes severe stiffness of the finger accompanied by redness, swelling and pain. This condition may also lead to destruction and rupture of the tendon. Therefore, it demands immediate surgical drainage.

Atypical mycobacterial infections

Atypical mycobacterial infections are tendon sheath infections caused by an atypical mycobacterium. These infections cause stiffness and swelling without much pain and redness. 

Antibiotic treatment is administered for several months, following which surgical removal of the infected tendon sheath may be performed.

Infections from bite wounds

Infections from animal or human bites are associated with bacteria such as Streptococcus and Staphylococcus, Eikenella corrodens (human bite injuries) and Pasteurella multocida (dog and cat bite injuries). These wounds are given initial treatment and left open to allow the infection to drain out. 

Surgical trimming of infected or crushed tissue may be done.

Related Topics:

Why you should take finger infection seriously | The New Times

A finger infection is a common condition. The hands as well as fingers are obvious tools which help us in physically interacting with other things around us, hence, more at the risk of being in touch with infectious bacteria and other germs. When these germs get inside the finger, they can cause an infection to the affected finger(s).

These germs can enter the finger through a tinny cut injury on the finger skin. Other ways these infectious bacteria can get access to inside the finger can be through animal bites (including human bites), insect bites or any sort of puncture wound on the finger.

There are different types of these finger infections, and with varying severity ranging from mild to potentially serious outcome. Often, these infections start out small and are relatively easy to treat. Failure to properly treat these infections can result in permanent disability or loss of the affected finger(s). Infection to the finger(s) can also spread to the palm and cause serious hand infections. 

Early recognition and proper treatment of these finger infections will help prevent most of these serious outcomes.

These infections might start at swelling of the fingertip or pad of fingertip, or swelling on the surface of the skin of the affected finger.

This infection may also start as swelling and pain of tissues on the edges of the finger near the nail root, as this area provides the perfect place for bacteria to enter the finger. Thus, the most common site of bacterial infection of the hand.

Less commonly, viral infection of the hand, usually on the fingers, can be caused by a herpes virus and is more commonly seen in healthcare workers whose hands are exposed to the saliva of patients carrying herpes.  This condition characterised by small, swollen, painful blood-tinged blisters and sometimes numbness, is typically mild and resolves on its own in several weeks without many after-effects. Still, proper medical evaluation should be sought to confirm this.

 The diagnosis of this finger infection will most times be made through listening to the history of the complaint and doing a physical exam. Other tests may be done to rule out other associated conditions which would make the disease to have a worse outcome, such as poorly controlled diabetes.

Once the diagnosis of a finger infection is made, medical treatment involves immediate aggressive antibiotics (usually injected into the vein), as well as a proper surgical cut to wash out all the possible formed pus. This maybe done as a day care case and the patient goes home on regular follow-up for any improvement or worsening, as well as for a proper full course of antibiotics. Other patients will require hospitalisation for the full treatment.

Preventive measures against these finger infections involve safety practices which help prevent many of the finger wounds that become a problem. Simple things, such as wearing protective work gloves, may prevent injury. Wearing latex gloves should be mandatory if possible exposure to bodily fluids is expected. Avoid chewing on one’s nails, and hand-washing is needed. Seeking early medical attention as soon as one thinks a finger infection is present is very important for the best outcome.

Dr Ian Shyaka , Resident in Plastic surgery, Rwanda Military Hospital,

[email protected]

Infections of the Finger — OrthopaedicPrinciples.com

Infection of the finger is a common problem that can vary in severity. Serious infection of the fingers may require urgent surgical care.

Felon
•Deep infection of the soft pad, or pulp of the fingertip. Usually the result of a puncture wound.
•Swelling or pus is trapped in the small compartments of the pulp or the tip of the finger.

Symptoms:
•Unusual redness or swelling
•Throbbing pain at the tip of the finger
•Firm swelling
•Visible pus

If the infection goes untreated, it may lead to severe symptoms such as skin necrosis, flexor tenosynovitis, osteomyelitis and arthritis of the distal interphalangeal joint.

Treatment:
•antibiotics if the infection is caught early.
•Surgery is the usual treatment: incision and drainage of the felon.

Paronychia
•Infection involving the soft tissues around the fingernail. Most common bacterial infection of the hand and is often associated with a simple hangnail.
Symptoms:
•Swelling
•Redness
•Pus formation
•Pain in the soft tissue around the nail plate.
Treatment:
•antibiotics if the infection is caught early.•Surgery is the usual treatment: incision and drainage with or without partial nail removal for subungal abcess.

Herpetic whitlow
•Painful infection caused by the herpes simplex virus that usually affects the fingers or thumb.
•Commonly contracted by dental workers and medical workers exposed to oral secretions and can occur in infants.
Symptoms
•Swelling and tenderness
•Redness
•Vesicle formation
•Fever
•Swollen lymph nodes
Treatment
•Conservative: the infection is self-limiting. Antiviral treatments applied to the skin (Acyclovir). Antibiotics are not used unless secondary infection is present. Drainage of the vesicles may lead to viral encephalitis.

Flexor tenosynovitis
•Relatively common infection of the hand usually caused by staphylococcus aureus. Usually occurs due to prior penetrating trauma and infection. The index, middle, and ring fingers are most commonly affected.
Symptoms
•Painful swelling of the finger that hurts worse with motion.

Kanavel’s four cardinal signs:
1-Uniform swelling of the entire finger
2-The finger is flexed
3-Intense pain when attempting to straighten the finger. occurs early.
4-Tenderness along the course of the tendon sheta. Most important sign.

Treatment
•If infection is caught early: IV antibiotics
•If infection is severe: open drainage. Early drainage of the infection to avoid skin loss, tendon necrosis, and osteomyelitis. The posterolateral incision is better than a zig-zag incision. Avoid indwelling catheter.
Infection may spread from the tendon into the deep palmar space or to the Parona’s space in the forearm. The little finger communicates with the ulnar bursa. The thumb communicates with the radial bursa. The radial and ulnar bursa communicate proximal to the carpal tunnel. Infection may travel from the little finger into the ulnar bursa to the parona’s space. Infection can also travel from the thumb into the radial bursa to the parona’s space. Infection may cause “horse shoe” tenosynovitis. Infection travels from the thumb through the radial bursa to the ulnar bursa infecting the little finger. may need combination of incisions for drainage

Post Views:
2,268

90,000 Topical antibiotics (applied to the skin) to prevent surgical site infections in wounds whose edges are sutured or otherwise secured

Relevance

The presence of microorganisms such as bacteria in postoperative wounds can lead to surgical site infections in patients. Surgical site infections in turn lead to increased health care costs and slower wound healing and pain.Antibiotics are medicines that kill bacteria or prevent them from growing. Antibiotics can be taken by mouth (orally), injected into a vein (intravenously), or applied to the skin (topically). Topical antibiotics are often used for postoperative wounds because they are believed to prevent surgical site infections. Topical antibiotics are considered to be preferable to oral and intravenous antibiotics. Because when applied topically, antibiotics work only on the area of ​​the body where they were applied, the likelihood of unwanted effects that affect the entire body, such as nausea and diarrhea, is reduced.It is also believed that when antibiotics are used topically, the likelihood of developing bacterial resistance is reduced (when bacteria become resistant to drugs). However, topical antibiotics can also have undesirable effects, the most common of which are allergic skin reactions (contact dermatitis) that cause redness, itching and pain at the site of application.

Review question

We reviewed the evidence of how effective topical antibiotics are in preventing surgical site infection when applied directly to wounds after surgery.We focused on the effects of topical antibiotics on tightly-bonded surgical wounds that heal faster (healing by primary intention). The edges of these wounds can be held together with sutures, staples, clips, or glue.

What we found

In May 2016, we searched for as many relevant studies as possible that looked at topical antibiotic use in surgical wounds that heal by primary intention.We identified 14 studies that compared topical antibiotics with no treatment or with antiseptics (other types of drugs applied to the skin to prevent bacterial infection) and other topical antibiotics. Eight of these clinical trials were conducted in general surgery departments and six in dermatological surgery (using only skin surgery). Many studies were small, of poor quality, or at risk of bias.After reviewing all of these studies, the authors concluded that the risk of developing surgical site infection was likely lower as a result of topical application of antibiotics to postoperative wounds when compared with antiseptics or no treatment. Since the development of infection after surgery is quite rare, the actual reduction in the incidence of infection was on average 4.3% when a topical antibiotic was compared with an antiseptic, and 2% when a topical antibiotic was compared with no treatment.An average of 24 patients (instead of antiseptic) and 50 patients (versus no treatment) will need to be treated with a topical antibiotic to prevent the development of one wound infection. Four studies reported the occurrence of allergic contact dermatitis, but there was insufficient evidence to determine whether dermatitis may develop more frequently with topical antibiotics than with antiseptics or no treatment. This also needs to be considered before deciding to use them.

This plain language summary is current as of May 2016.

Herpetic felon. Case report. – Evidence-based medicine for all

The mother went to an outpatient appointment with a general practitioner on 10/07/2013 about the illness of her child (age 1 year 3 months, girl), with complaints of an increase in body temperature to 38-39 degrees, limping on her left leg; swelling, pain, violation of the integrity of the skin and oozing in the area of ​​the first toe of the left foot.They live in the countryside.

Krusiv highlighted reference information.

General information about herpetic whitlow. The cause of herpes felon is herpes simplex viruses of the 1st and 2nd types. The primary infection develops through direct penetration of the virus through damaged skin (inoculation).

Recurrent infection: A patient may develop herpes felon as a result of reactivation of a latent virus months or years after the initial infection.

Medical history: Considers the child sick since October 4, when she first noticed his malaise, moodiness and lethargy. On October 5 (Saturday) the child had a fever for the first time, the mother noticed that the daughter often touches the 1st toe of her left foot, there was “redness” on the toe. She tied an aloe leaf to her finger for several hours. On October 6 (Sunday) in the morning, I found a bubble on 1 toe of the left foot, in the area of ​​the back of the toe, just behind the nail. The bladder was tense, had transparent contents, and was about the size of a fingernail.In addition, the child’s temperature rose to 39, moodiness increased, and his appetite dropped. The mother went by gravity to the admission department of pediatric surgery at the regional hospital, the child was examined by a pediatric surgeon, the bladder was opened. Diagnosed with “Allergic reaction to aloe”, prescribed: aseptic dressings, lotions with Dimexidum (1:10 with furacillin solution 1: 5000), Suprastin 1/4 tablet 3 times a day. Treatment is on an outpatient basis, examination in dynamics by a regional surgeon.

Pathogenesis, history, course features. After infection, the herpes simplex virus of the first or second type begins to replicate in the cells of the dermis, the sensory ganglion may be involved in the process. Clinical symptoms appear 2-20 days after infection.

Herpetic felon – clinical diagnosis. There may be a history of trauma to the periungual region, although more often patients deny the physical impact. When interviewed, you can identify autogenous or exogenous contact with herpes labialis or genital herpes.Coexisting primary lesions in the mouth or genitals confirm autoinoculation

Life history: Healthy child, happy family; upbringing, hygiene and care in the family are satisfactory. She grew and developed according to her age. Vaccinated according to the National Vaccination Schedule. From the transferred diseases only infrequent ARVI and sudden exanthema (“sixth disease”). She is still actively breastfeeding.

Epidemiological history: Everyone is healthy in the house, there are no rashes, fever, no pustular diseases. The day before (October 3), the mother had a peak of another exacerbation of labial herpes; at the time of examination by a GP, the mother had only a small “tubercle” on the red border of the upper lip. She also notes an injury to the skin of the 1st finger: a few days ago (it is difficult to name the date) she cut the child’s nails and “pinched” the skin along with the nail; the child pulled his leg in pain, but there was no bleeding.

Epidemiology. Herpetic felon occurs at any age. Most often, this pathology is observed in children sucking fingers, and in medical workers in contact with the oral mucosa of patients without gloves (for example, dentists, pulmonologists). Other risk groups include wrestling athletes, adolescents after contracting genital herpes. The incidence of herpetic panaritium is estimated at 2.4 cases per 100,000 population.

On examination: General condition of moderate severity.The child is communicative, sociable, does not react to a doctor’s examination with crying or protest, trusting, easily carried away by the proposed toys. Temperature 38.2, in organs and systems without deviations.

Prevalence and transmission of infection. Herpes simplex virus (HSV) is widespread and is most commonly transmitted through direct physical contact. The most common localization of infection is the oral mucosa (HSV-1) or the genital mucosa (HSV-2). In rare cases, infection can spread to the distal phalanx through direct inoculation and cause pain, edema, erythema and blistering, which is the clinical picture of herpetic felon.This diagnosis is of particular importance given its close resemblance to paronychia and its dramatically different treatment.

Local: hyperemia and moderate edema of the first toe of the left foot. On the dorsum of the distal phalanx, the remnants of the epidermis from the opened bladder, pronounced exudation: almost the entire 1st toe and the adjacent part of the second toe are macerated. On palpation, the pain is moderate. On the lateral and dorsal surfaces of the first toe, there are multiple, barely noticeable vesicles with a thick cover (due to the physiological thickening of the epidermis on this part of the body), apparently with transparent contents.Vesicles are difficult to distinguish from papules, however, in the largest ones, a colorless exudate is still visible. Photo (to view it in full format, click on the photo, to return to the article, you can use the “back” button of your browser)

Clinic for herpes felon. Patients often experience pain and tingling in the toe before skin changes (prodromal phase). Local soreness, erythema and edema then develop with the appearance of the first vesicles, which are most common along the surface of the finger and around the nail.The infection usually affects only one finger, but in rare cases, multiple fingers may be affected. The bubbles usually coalesce into large, honeycomb-like bullae. They can spread proximally and involve the nail bed, where hemorrhagic lesions can occur. Patients often report disproportionate pain intensity, especially when the nail bed is affected. Fever, lymphadenitis, and axillary lymphadenopathy may occur. In rare cases, lymphedema of the hand and forearm may occur.In most of the cases described, we are talking about bacterial superinfection.

The vesicular fluid becomes clear at an early stage, but as it progresses, it can become cloudy, serous-purulent, or hemorrhagic. There will never be overt pus if there is no bacterial superinfection. In immunocompromised patients (especially AIDS patients with CD4 counts less than 50) ulceration and necrosis may occur.

Based on clinical data and epidemiological data, the diagnosis was made: Panaritium caused by the herpes simplex virus.ICD code B00.8 Due to the remoteness of the laboratories and the obvious clinical picture, laboratory confirmation of the diagnosis (PCR of the contents of the vesicles, ELISA of blood for IgM to gerpes simplex) was not carried out.

Diagnostics. As noted above, herpetic felon is a clinical diagnosis. A vivid clinical picture of panaritium without classic, typical pus and an epidemic history make it possible to clarify the diagnosis. In difficult cases, the following additional research methods are available:

Viral culture: Direct virological examination of vesicles and vesicular fluid.The sensitivity of the method is 50%. The highest concentration of viruses in vesicles is in the first 24-48 hours of their appearance. Polymerase chain reaction (PCR) is a much more sensitive study.

Tsang test – scraping the herpetic vesicle, Giemsa staining and identification of multinucleated “balloon” giant cells. The sensitivity of the method is approximately 70% with a high specificity for the disease.

The differential diagnosis primarily includes paronychia and classic bacterial felon.A pale yellow blister may indicate a purulent infection, but incision or puncture aspiration does not reveal overt pus.

Treatment prescribed:

1. acyclovir 100 mg – 5 r per day, 5 days.
2. Zovirax cream topically 3 times a day
3. lotions with miramistin, asepsis
4. prohibit water procedures.
5. Anesthesia: Nurofen 7 ml * 3-4 times a day regularly until the pain syndrome disappears

Treatment. Symptomatic treatment and prevention of secondary infection are the mainstay of therapy for herpes felon. The natural course of infection in an immunocompetent patient is the spontaneous disappearance of symptoms within 2–4 weeks.

Incision and drainage should not be performed as this does not provide symptomatic relief and may cause viremia and bacterial superinfection. Significant pain relief has been reported after excision of the nail segment to decompress vesicles along the nail bed.
Although there is little research on herpes felon, one study showed that antiviral drugs shorten the duration of symptoms by 4 days and reduce the number of days the virus is shed.

Treatment is more effective if antiviral therapy is started within 48 hours of symptom onset.

For recurrent herpes lesions, suppressive antiviral therapy may help.Comparative studies of the effectiveness of antiviral drugs (acyclovir, famciclovir, or valacyclovir) have not been conducted.

Consider the need for antibiotic therapy in the presence of secondary bacterial infection

Viral shedding occurs until the affected epidermis heals, therefore patients should be informed of the importance of wearing gloves or using other barrier measures.The patient should be informed that the likelihood of relapse is 30% to 50%.

SECOND RECEPTION

fourth day of illness

08 10 2013

Complaints of pain when walking, when putting on a sock; on an increase in temperature up to 38 degrees, tearfulness of the child.

Local: profuse weeping, no signs of bacterial infection; from strong maceration, the vesicles became obvious, more protrude above the surface of the skin and are very noticeable, especially due to the appearance of hyperemia of intact skin.The swelling increases. The content of all vesicles is transparent. Treatment: continue unchanged

Photos:

THIRD RECEPTION

fifth day of illness

Complaints of pain when walking, when putting on a sock – is growing in dynamics; an increase in temperature up to 39 degrees, tearfulness, a noticeable deterioration in the general condition of the child.

Locally: profuse oozing, the nature of the exudate is purulent (light white liquid abundant pus), hyperemia of intact skin grows, edema grows.The contents of all the vesicles are cloudy. Attachment of the bacterial flora is obvious. There are no new elements of the rash (vesicles), which means that the herpetic component of the disease fades into the background, the secondary bacterial infection comes to the fore. There is no fluctuation. The finger is hot to the touch. The edema has spread to the middle of the dorsum of the foot.

Treatment:

1. Augmentin 125 mg 3 times a day
2. baneocin ointment topically 3 times a day
3. take acyclovir orally continue for another day

Photos:

FOURTH RECEPTION

sixth day of illness

10.10.2013

Complaints of pain when walking, when putting on a sock – is growing in dynamics; on an increase in temperature up to 39 degrees, tearfulness, deterioration of the general condition of the child, lack of appetite. The baby drinks only the mother’s breast milk. The mother reported that after the first intake of Augmentin, the child vomited profusely. After 6 hours, she gave the child a second dose of Augmentin – and the child vomited again profusely. The mother was afraid to give the third, evening dose of Augmentin.

Local: all vesicles are tight and abundantly filled with white pus.In those places where the vesicles were located especially densely, they merged into bullae, containing a fairly large amount of pus. The edema is pronounced. The finger is hot to the touch. The edema has spread to the middle of the dorsum of the foot.

Treatment:

1. Acyclovir Cancel
2. opening blisters, creating conditions for the outflow of pus
3. ceftriaxone intramuscularly at 500,000 U per 1% lidocaine, once a day, 5 days.
4. antibacterial ointment should be canceled, the wound surface should be dry-treated, an aseptic bandage should be applied three times a day, and the old bandage should be soaked with miramistin before removing.

Photos before the bubbles burst:

Photo after opening bubbles:

The bullae were opened with a sterile syringe needle, Y-shaped incisions, the edges were divorced, the wounds were washed with 3% hydrogen peroxide, with a stream.

FIFTH RECEPTION

seventh day of illness

11 10 2013

Complaints have significantly decreased, the mother notes a pronounced positive trend. The body temperature returned to normal values, a slight appetite appeared, pain and swelling began to decrease.

Locally: opened bullae still exude a meager amount of pus, however, a decrease in the severity of exudation and maceration is noticeable.The swelling subsides.

Treatment:

1. prescribed treatment continue
2. Dissection of the largest of the individual pus-filled vesicles.

SIXTH RECEPTION

tenth day of illness

14.10.2013

Complaints pronounced positive dynamics. The flow of pus has stopped. The wounds dry out, itch.The child does not react with pain to palpation of the finger, pulls the leg out of habit rather than pain. The temperature did not rise anymore, the appetite returned, the child is cheerful and playful.

Local: places of maximum maceration are covered with light golden-hemorrhagic crusts, edema subsides, diapedetic hemorrhages in all bullae and vesicles, the finger acquires a purple-purple tones.

Treatment:

1. Last injection of ceftriaxone (fifth injection)
2. topical treatment stop completely
3. allow water procedures, except for prolonged steaming in hot water of the affected areas

Photos:

SEVENTH RECEPTION

twelfth day of illness

16.10.2013

Complaints: severe itching at the site of the former skin lesions. There are no other complaints.

Local: edema slowly but invariably decreases, hemorrhages in the cavity of the former vesicles and bullae have become even more noticeable and give the finger in places a blue-black color. There is an active epithelialization of the affected areas.

Treatment: no longer required. The mother is warned about the long time for the resorption of hemorrhages; a follow-up examination by a general practitioner is recommended in a week, on the day of a healthy child.

Photos:

Forecast. A herpetic infection of the fingers usually resolves on its own within 2-4 weeks. After the stage of exacerbation, the pain subsides, the vesicles begin to dry and become crusty. The pain usually goes away after about 14 days, and the remaining skin changes heal after that. Healing usually goes away without problems, although there are reports of residual scarring, numbness, and hypersensitivity. Recurrence of the disease due to latent infection in the sensory ganglia is observed in 30-50% of cases.

The mother’s certificate of incapacity for caring for the child is closed.

To start work from 17.10.2013

All treatment was carried out in a rural department of general medical practice, by a general practitioner. Hospitalization or third-party consultations of “narrow” specialists were not carried out, additional laboratory examinations were not carried out either.

The case is a very clear example of a typical course of herpetic felon, complicated by a bacterial infection.

90,000 fungus between fingers treatment drugs

fungus between fingers treatment drugs

It should be noted that Dolgar gel is not sold in the pharmacy. We, as an official manufacturer, do not supply the product to physical points of sale, because because of this, the total cost would have to include the costs of paperwork, organization of transportation and salaries of employees. To keep the price as low as possible, we sell the remedy for Dolgar fungus only through our official website

cream for all types of skin fungus, addresses of nail fungus treatment
foot skin fungus photo
foot baths for fungus with vinegar
the most effective fungus treatment
candid nail fungus cream reviews

You can learn how to cure the fungus between the toes with Exoderil on our website. warm environment1,11 Possible pathogens of fungal infection – dermatophytes – are parasitic fungi that can feed on keratin.The causative agent of the fungus can get on the human skin, and thus infection occurs1,4. This can result in discomfort between the toes, such as peeling and itching. An unpleasant odor may appear in the area of ​​the foot. The skin in the spaces between the fingers is the most vulnerable place for fungus. If a bacterial infection joins the disease, purulent ulcers appear on the skin. Preparations for the treatment of fungus: how to choose Preparations intended for the prevention and treatment of fungal infections are called antimycotics.By the mechanism of action directed against fungi, antimycotic agents can be divided into two types: fungicidal – they destroy the spores of fungal infection; fungistatic – inhibit the activity of microorganisms (but do not kill) and prevent the spread of infection. The names of ointments from the fungus between the fingers. Lamisil 1% is a drug based on terbinafine, a substance that has a detrimental effect on fungi on the skin and nails. Kanizon is an ointment based on clotrimazole, which destroys fungal cells; Mycospore is an active drug often used to get rid of dermatophytes, mold and yeast-like fungi.The need to use this drug, the appointment of the treatment regimen, methods and dose of the drug are determined exclusively by the Attending physician. Self-medication is dangerous to your health. ILive does not provide medical advice, diagnosis or treatment. Symptoms of toe fungus. A crack or funnel appears between the toes, the edges of which are covered with whitish or greenish squamous (flaky) skin; The crack can be weeping with exudate. If you sabotage the treatment of the fungus between the toes, 80-100% of patients will be affected by the toenails, and 20% will be affected on the hands.The look is sad and repulsive, the nail looks like crumbling dust or laundry soap. It can also take on the appearance of a claw of a vulture or grow in. You can also treat with local drugs that are applied to the lesions. Such drugs often have a wide range of effects, and kill both fungi and bacteria. The form of the fungus remedy is as important as the components of the composition. There are always fats and oils in ointments, such drugs are absorbed deeply and slowly, but they last longer. Creams are absorbed more easily, but do not penetrate deeply. those that cause skin lesions tend to grow rapidly, causing unpleasant sensations to the expectant mother.Miconazole, exoderil, nizoral, lamisil and desenex also do an excellent job with the fungus between the fingers. To prevent re-infection with toe fungus, you need to wear open shoes, change socks every day, and treat the inside of the shoes with vinegar, formalin or chlorhexine solutions.There are many alternative treatments for fungus between the toes that also work well with regular use. The most popular alternative methods of treating a fungus, which are attractive because of the cheapness and ease of preparation of the drug, are as follows What is mycosis of the feet? We will analyze the causes of occurrence, diagnosis and treatment methods in the article by Dr. Yanets.E., a dermatologist with 15 years of experience. Above Dr. Janetz’s article. E. worked as a literary editor Yulia Lipovskaya, scientific editor Vladimir Gorsky and chief editor Lada Rodchanina. Yanets Olga Evgenievna The emergence of modern antifungal drugs made it possible to improve the epidemiological situation, but mycosis of the feet still remains one of the most significant problems in dermatovenerology. The use of some drugs is limited in the elderly and patients with chronic diseases [19]. Prevalence of mycosis of the feet.Effective remedies for the treatment of toenail fungus at affordable prices with delivery to the nearest pharmacy in our network – online pharmacy Be Zdorov !. Types of remedies for nail fungus. Preparations from the fungus for external use. Creamy remedies against nail fungus. Nail fungus varnishes. Sprays and solutions for the treatment of fungus and disinfection. Pills against nail fungus. Preparations for the treatment of fungus for pregnant and lactating women. All the proposed drugs conditionally differ in the way they are used and in composition.Means for combating different types of fungi – antimycotics – are available in affordable and convenient dosage forms in their own way. Special ointments are used to treat fungal infections on the feet. The active substances in their composition kill harmful microorganisms and contribute to the restoration of the skin.They have a destructive effect on fungi and remove unpleasant symptoms. After their application, the skin is quickly restored. For the treatment of mycosis, the following types of drugs are produced: Azole-based ointments.They are distinguished by a narrowly targeted action and allow you to successfully fight against certain types of fungi. Allylamine-based ointments. These funds are characterized by a wide range of actions. Broad spectrum topical preparations against nail fungus. Antifungal agents for candidiasis. Treatment of skin fungus – broad spectrum preparations. Are broad-spectrum antifungals prescribed for pregnant and lactating women? Why do we need a wide range of antifungals The most toxic drugs for the treatment of deep lesions are sold only by prescription: in these cases, complex therapy will be required, with the use of tablets – antibiotics and antimycotics, as well as the use of external formulations in the presence of manifestations on the skin or nails.Antifungal drugs for the early stages of the disease are available over the counter.

foot skin fungus photo fungus between toes treatment drugs

cream for all types of skin fungus
addresses nail fungus treatment
foot skin fungus photo
foot baths against fungus with vinegar
The most effective fungus treatment
candid cream for nail fungus responses
butcher doctor fungus treatment
Fungus treatment with soda and salt

fungus between toes treatment preparations foot baths against fungus with vinegar

doctor of butchers fungus treatment
fungus treatment with soda and salt
soda against fungus on the feet
how to use ointment for nail fungus
exostat from fungus reviews ointment
toenail fungus consequences

Dolgar from nail fungus reviews Natural preparation in the form of a gel from nail fungus, this is how an ointment called Dolgar is advertised on the Internet, moreover, on selling sites they persistently repeat the mantra about the ineffectiveness of pharmacy remedies for mycosis.It’s funny, because Dolgar is not a drug, not a medicine, but just cosmetics for the skin. Promotes complete restoration of the nail, heals deep cracks. It also destroys fungal spores and protects against re-infection. Disinfects and softens the skin, the product comfortably cools the foot and gives it a pleasant aroma.

Clinical blood test with leukocyte formula (5DIFF) (venous blood)

General (clinical) blood test with the formula is the main laboratory test, most often prescribed for any pathological process.A blood test with the formula includes determining the number of all blood cells (erythrocytes, leukocytes, platelets), determining the hemoglobin content, hematocrit, erythrocyte counts (MCV, MCH, MCHC).

In what cases is a clinical blood test with a formula usually prescribed?

This study is assigned in preparation for hospitalization and planned surgical interventions, with annual medical examination, repeatedly during pregnancy, in children before any vaccination.

For any disease, a complete blood count with a leukocyte formula is a study that provides the necessary information about the patient’s current condition. The presence of anemia and hematological diseases, the severity of inflammation and the response of the body’s immune system, indicators of the allergic process and possible signs of helminthic invasion – this information can be obtained from a clinical blood test with the formula.

What exactly is determined in the analysis process?

Erythrocytes (RBC, red blood cells, “red blood cells”) – non-nuclear blood cells containing hemoglobin.The shape of erythrocytes in the form of a biconcave disc provides an increase in their surface area and an increase in the possibilities of gas exchange; gives plasticity when passing through the capillaries. The main function of red blood cells is to transport oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs. Determination of the number of erythrocytes has the most important diagnostic value in the diagnosis of anemia in combination with the determination of hemoglobin, hematocrit, erythrocyte indices.

Hemoglobin (Hb, HGB, hemoglobin) is the main component of erythrocytes, the structure consists of protein (globin) and iron (heme), the main function is the transport of oxygen and carbon dioxide and their exchange between the lungs and body tissues.The hemoglobin level depends on gender, age, height of residence above sea level (residents of highlands have a higher hemoglobin), smoking. Hemoglobin is measured in grams per 1 ml of blood, therefore, when assessing the level of hemoglobin, you need to pay attention to the hematocrit. An increase in hematocrit (usually associated with dehydration) can falsely overestimate the hemoglobin concentration.

Hematocrit (Ht, Hematocrit) – the percentage of erythrocytes from the total blood volume, reflects hemoconcentration. Determination of hematocrit is used to assess the degree of anemia, to calculate erythrocyte indices.Changes in hematocrit do not always correlate with changes in the total number of erythrocytes; therefore, the hematocrit value is difficult to interpret immediately after acute blood loss or blood transfusion.

MCV (Mean Cell volume) – average erythrocyte volume, calculated value. The average erythrocyte volume is used in the differential diagnosis of anemia. By the value of MCV, normocytic anemias are distinguished (MCV 80-100 fl in adults and children from 5 years old), microcytic (MCV less than 80 fl) and macrocytic (more than 100 fl).In the presence of erythrocytes of different shapes (anisocytosis) or a large number of erythrocytes with an altered form of MCV, it may not be informative enough.

MCH (Mean Cell Hemoglobin) – the average content of hemoglobin in an erythrocyte (in 1 cell). The calculated indicator, according to the clinical value of the MCH, is similar to the color indicator, but is more reliable, it is calculated in absolute units (pg). It is used in the differential diagnosis of anemia. Based on the MCH index, normochromic, hypochromic and hyperchromic anemias are distinguished.

MCHC (Mean Cell Hemoglobin Concentration) – the average concentration of hemoglobin in erythrocytes. Indicator of the degree of saturation of the erythrocyte with hemoglobin. This is a concentration index that does not depend on the volume of the cell. ICSU is a sensitive indicator reflecting changes in hemoglobin formation; is relevant in the diagnosis of iron deficiency anemias, thalassemias, some types of hemoglobinopathies.

Rel. Red cell distribution width (RDW, Red cell Distribution Width) is a measure of the difference in red blood cells by volume.In the blood of a healthy person, erythrocytes differ slightly, and the RDW index is in the range of 12-15%. RDW above normal reflects the heterogeneity (heterogeneity) of erythrocytes (degree of anisocytosis). It is used in the differential diagnosis and monitoring of the treatment of anemia.

Platelets (PLT, Platelets) are blood cells involved in clotting. They are nuclear-free cytoplasmic fragments of their precursors – megakaryocytes, which are formed in the bone marrow. The average life span in the bloodstream is 10 days.In a calm state, platelets have a disc-like shape, when activated, they become spherical and form special outgrowths – pseudopodia, due to which they connect to each other and adhere to the vascular wall (the ability to aggregate and adhere), while releasing biologically active substances that contribute to the restoration of the vascular wall in case of damage (angiotrophic function). Platelets stop bleeding in small vessels (platelet-vascular hemostasis).

Determination of the number of platelets is used to assess the risk of thrombotic and hemorrhagic complications, in hemorrhagic syndrome, in a comprehensive examination of the blood coagulation system, for monitoring during chemotherapy. There may be fluctuations in platelet levels during the day.

Leukocytes (WBC, White Blood Cell) – cells of the immune system, their ratio and maturity is determined in the leukocyte formula.

In the leukocyte formula, you can normally see the following cell populations and their percentage: neutrophils, monocytes, lymphocytes, basophils, eosinophils. Normally, these cells are present in the blood in relatively stable amounts. Their ratio depends on age. In children under 5-6 years of age, lymphocytes predominate in the blood formula, in adults, there is a clear predominance of neutrophils.

What do the test results mean?

Leukocytes: An increased number of leukocytes (leukocytosis) can be a sign of infection (both bacterial and viral, a marker of current inflammation (including autoimmune or allergic), a sign of hematological disease.

A decrease in the level of leukocytes (leukopenia) can be associated with severe infection (up to sepsis), with the toxic effect of drugs taken, with damage to the bone marrow.

Neutrophils: An increase in neutrophil count may be associated with bacterial infection, inflammation, trauma, severe stress, or early postoperative period.

A decrease in the number of neutrophils is usually associated with drug reactions, autoimmune diseases, immunodeficiency conditions, and bone marrow damage.

Lymphocytes: An increase in the number of lymphocytes (lymphocytosis) can be observed in acute viral infections, infections of the herpes group (EBV infection, CMV infection, etc.), in some bacterial infections (whooping cough, tuberculosis intoxication), chronic inflammatory diseases (for example, ulcerative colitis), lymphocytic leukemia.

A decrease in the number of lymphocytes (lymphopenia) is often associated with autoimmune diseases, chronic viral infections (HIV, viral hepatitis), exposure to the bone marrow, and the use of corticosteroids.

Monocytes: Monocytes can increase with long-term chronic infections (tuberculosis, fungal infections), connective tissue diseases and vasculitis, monocytic or myelomonocytic leukemia.

A short decrease in the number of monocytes has no diagnostic value. A prolonged decrease in the number of monocytes, combined with another pathology in the blood test, may be associated with aplastic anemia or bone marrow damage.

Eosinophils: An increase in the number of eosinophils may be associated with parasitic invasions, asthma, allergies, inflammatory diseases of the gastrointestinal tract.

The absence of eosinophils in the blood count may be normal and has no clinical significance.

Basophils: An increase in the number of basophils can be observed in rare allergic reactions, chronic inflammatory diseases, renal failure (uremia).

Decrease or absence of basophils has no clinical significance.

Thrombocytes: In addition to true thrombocytopenias (reduced platelet count), the occurrence of such a rare phenomenon as EDTA-dependent thrombocytopenia is possible. Currently, to perform a general blood test, blood is drawn into tubes with an anticoagulant – EDTA. In rare cases, the interaction of the patient’s blood with EDTA leads to aggregation (sticking) of platelets among themselves and the impossibility of accurately counting their number.In this case, the analyzer is not able to isolate these cells and count them accurately, which can lead to a false underestimation of the number of platelets in the blood. If a low platelet count is detected by the analyzer, the laboratory conducts microscopy of the blood smear and gives a conclusion about the presence of platelet aggregates in the smear.

Normal test due date

Usually the result of a clinical blood test with the formula can be obtained within 1-2 days

Do I need special preparation for the analysis?

No special training required.You can take the test 3 hours after a meal or on an empty stomach. Blood is usually drawn from infants before the next feed.

A woman caught a deadly infection while unpacking a box: People: From life: Lenta.ru

A resident of the American state of Hawaii contracted a deadly infection due to a cut received when unpacking boxes during the move, and nearly lost her arm. This is reported by The Mirror.

In December 2017, 46-year-old Heather Harbottle moved into a new home and accidentally cut her finger on paper while unpacking boxes of belongings.The next day, she woke up with severe pain in her arm. Her finger became inflamed and began to swell, any movement brought unbearable pain.

Harbottle was hospitalized. It turned out that she contracted a staphylococcal bacterial infection that developed into sepsis. Doctors diagnosed her with necrotizing fasciitis, a bacterial infection that causes tissue death.

Doctors gave Harbottle disappointing predictions: from arm amputation to death. The patient was biopsied and prescribed multiple antibiotics.Every three days, her wound was cleaned and the affected tissue removed.

The American was supposed to have a skin graft, but the bacteria spread to her forearm and her condition worsened. The patient was taken by helicopter to another hospital, where she underwent surgery on her forearm and ring finger, which had a cut. In January 2018, she underwent a transplant procedure: part of the skin from her groin was transplanted onto her arm.

Shortly thereafter, Harbottle’s health improved.She is engaged in occupational therapy to restore the movement ability of her hand. She is now seeking to raise public awareness of necrotizing fasciitis.

Earlier it was reported that a resident of the English city of Bristol, Shirley Hare, almost died after a cat named Chan scratched her hand. The pet unwittingly brought a bacterial infection into the wound, after a few days the injured hand began to turn black.

More interesting and surprising – in our Instagram. Subscribe!

What to do in case of a tick bite and where to go?

The most popular questions about tick bites are answered by Maria Andreevna Belopolskaya, an infectious disease physician at the V.I.S.P. Botkina

What are the most dangerous infections that ticks carry?

St. Petersburg and the Leningrad Region are endemic areas where ticks are common, which are carriers of such infections as tick-borne encephalitis, borreliosis, granulocytic anaplasmosis and monocytic ehrlichiosis.

The most dangerous infection transmitted by ticks is tick-borne encephalitis. It is a viral infection characterized by fever, intoxication and damage to the gray matter of the brain and the membranes of the brain and spinal cord.In severe cases, it can lead to death.

Borreliosis, anaplasmosis and ehrlichiosis are bacterial infections that can be treated with antibiotics.

How to protect yourself from tick-borne infections?

The most effective way to prevent tick-borne encephalitis is vaccination. Vaccination is carried out in all children’s and adult clinics. Routine vaccination begins in the fall, then after 5-7 months the second vaccination is given, after 1 year – the third and then once every 3 years.Emergency vaccination in the summer is also possible, but in this case, during the course of vaccination and for another 2 weeks after vaccination, it is impossible to visit forests in order not to meet ticks.

Ticks are most active in May, early June, but the risk of being bitten remains throughout the warm period. When going out into the forest, you should wear protective clothing, be sure to cover your hands and head, and treat your clothes with repellents. After leaving the forest, examine the skin, change clothes. Pets should be examined as they can bring ticks from the forest on them.

Do not drink raw milk, as tick-borne encephalitis can be transmitted from an infected animal through milk.

What to do if bitten by a tick?

In case of a tick bite, it is necessary to urgently contact the nearest trauma center, where the tick will be removed and sent for research, and the bite site will be examined and processed.

You can remove the tick yourself. There are several important points to keep in mind. The tick must be pulled out entirely together with the head.You cannot press it with your fingers, since when pressed, a larger number of tick-borne pathogens can enter the bloodstream. You can not drip oil or alcohol on the tick, this leads to the fact that the tick begins to suffocate and more intensively throws the contents of the intestine into its victim, which increases the risk of infection. The removed ticks must be brought for laboratory testing.

What to do if a tick test reveals the presence of a virus?

The adult population is injected with a specific immunoglobulin for a prophylactic purpose within 3 days from the moment of the bite, if the test of the tick for the tick-borne encephalitis virus turns out to be positive.If symptoms of tick-borne encephalitis are detected, the patient is necessarily hospitalized in an infectious diseases hospital for intensive treatment.

If borreliosis or other bacterial infections are detected in the tick, the patient is prescribed a course of antibiotics.

Arpimed

Possible side effects

Like all medicines, Silvadev can cause side effects, although not everybody gets them. Silvadev may cause the following side effects:

Often (less than 1 in 10, but more than 1 in 100 people):

• Irritation.
• Rash around the wound (including eczema and contact dermatitis).
• Decrease in the level of leukocytes in the blood (leukopenia). This can lead to an increased risk of developing infections. Typically, white blood cell counts return to normal within a few days; however, your healthcare provider should carefully monitor your condition to make sure your white blood cell counts return to normal.

Rare (less than 1 in 1000, but more than 1 in 10,000 people):

• Skin discoloration (accumulation of silver in tissues as a result of application over a long period of time).

Very rare (less than 1 in 10,000 people):

• Renal failure. Tell your doctor if you have difficulty urinating, polyuria or oliguria, or if you notice blood or sediment in your urine. This could be a symptom that your kidneys are not functioning properly.

Reporting side effects:

If you notice any side effects, tell your doctor, pharmacist or nurse.This includes any possible side effects not listed in this package insert. You can also report side effects to Arpimed LLC by going to the website www.arpimed.com and filling out the appropriate form “Report side effects or drug ineffectiveness” and to the Scientific Center for the Expertise of Drugs and Medical Technologies named after Academician E. Gabrielyan by going to the website www.pharm.am in the section “Report side effects of the drug” and fill out the form “Card of messages about side effects of the drug”.Scientific center hotline: +37410237665; +37498773368

How to store Silvadev

• Keep out of the reach of children, protected from moisture and light, at a temperature not exceeding 15 ^o C.
• Shelf life – 3 years. Do not use the cream after the expiration date indicated on the drug packaging. The expiry date refers to the last day of the specified month.
• Do not use the cream if you notice any visible signs of deterioration, for example, the cream turns dark brown or black.Purchase a new pack of the drug.

Silver salts, reacting with atmospheric oxygen, metals and other chemical components, especially when catalyzed by heat, darken, so the drug should be stored in a closed container and away from heat sources.

Do not empty any medicinal product into waste water or sewage system. Ask your pharmacist how to dispose of a drug you no longer need. These measures are aimed at protecting the environment.

Contents of the box and additional information

What Silvadev contains

Each gram of Silvadev, 1% cream for external use contains:

active substance: silver sulfadiazine – 10 mg;

excipients: cetostearyl alcohol, heavy liquid paraffin, propylene glycol, glyceryl stearate, polysorbate 80, methylparaben, purified water.