Chronic paronychia – Sussex Community Dermatology Service

What are the aims of this leaflet?

This leaflet has been written to help you understand more about chronic paronychia. It will tell you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is chronic paronychia?

Paronychia is a common infection of the skin around the fingernails (the nail folds). ‘Acute paronychia’ is the term used for short-lived episodes; ‘chronic paronychia’ is used if it lasts for more than 6 weeks. The condition can last for months or even years.

What causes chronic paronychia?

Chronic paronychia is not caught from someone else. The bacteria that cause it are known as ‘opportunistic pathogens’. This means they cause infection only when conditions are right, such as when you have an open wound. In the case of chronic paronychia, this is often a split in a cuticle, which normally protects and seals off the potential space between the nail and the nail fold.
A swab from an infected nail fold will often grow a mixture of bacteria and yeasts in the laboratory, rather than just a single type. Some of these can discolour the nail.
Women get chronic paronychia three times as often as men. It is particularly common in those who:

• have their hands constantly in water and detergents (without protective gloves), or bakers who work with flour
• have a poor circulation, and therefore cold hands and feet
• push back their cuticles
• have diabetes

Is chronic paronychia hereditary?

No.

What are the symptoms of chronic paronychia?

It causes repeated episodes of tenderness and swelling of affected nail folds, which may be one or several. The nails may also have a discoloured or ridged appearance, which can be cosmetically unacceptable for some people.

What does chronic paronychia look like?

It starts in the nail fold at the base of one nail, but often spreads up beside the nail. All nails in the hands can be affected, as predisposing conditions such as hand-wetting are common to all the nails.

The main changes are:

• areas of swelling at the base or sides of one or more nails. The skin becomes red, shiny and tender, and the nail fold separates away from the nail.
• loss of the cuticle in inflamed areas.
• pus, – white, yellow or even greenish – can be squeezed out in small amounts from inflamed areas.
• the nail itself may grow out ridged and become discoloured. This can be apparent for many months after the paronychia has cleared. as the nail slowly grows out.

How is chronic paronychia diagnosed?

The red swollen nail folds of chronic paronychia give it a characteristic lookso your doctor will be able to make the diagnosis without laboratory tests. It should not be confused with ringworm (tinea) infection, in which the nail itself, but not the nail fold, will be affected.
Other conditions such as psoriasis and lichen planus can also affect the nails and cause ridging and discolouration.
Your GP may wish to:

• check your urine for sugar to make sure you are not diabetic.
• take a swab from an inflamed nail fold to see which germs are present (for example bacteria or the yeast that causes thrush) as this may influence treatment.

Can chronic paronychia be cured?

Yes – but remember that just as it starts slowly, it also clears slowly.

How can chronic paronychia be treated?

To work well, treatment has to alter the things that started it; this is not always easy. It may take as long as six months for the cuticle to reform, and until it does, the problem may recur.
Acute paronychia needs antibiotic tablets by mouth. If forming pus, it may need surgical drainage.
Chronic paronychia:

• Usually an antibacterial and/or antifungal cream or lotion improves the condition within a few weeks. Sometimes a steroid cream in addition speeds up improvement.
• If the above is not successful then antibiotic or antifungal tablets might be needed.
• Surgery is not usually needed, but sometimes can help clear the condition if medical treatment fails.
• Predisposing factors such as frequent hand-wetting must be addressed to help the nails improve.
• Underlying conditions such as diabetes and poor circulation must also be treated to help improve paronychia.

What can I do?

• You should keep your hands as warm and dry as possible; you will not get better until you do this.
• Wear gloves for any wet tasks, including shampooing and washing up.
• Avoid biting your nails, manicuring your nail folds, and pushing back the cuticles.
• Do not use nail varnish until the condition has been treated.
• Occasionally a change of occupation is worth thinking about.
• Do not apply false nails until the condition is resolved.

Where can I get more information?

Web links to detailed leaflets:
http://www.dermnetnz.org/fungal/paronychia. html

Paronychia | Symptoms of a Nail Infection & How To Treat It

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What is paronychia?

When the skin around your fingernails or toenails gets infected, it’s called paronychia.

The skin next to the nail is called the nail fold. Most of the time, paronychia is caused by bacteria (usually Staphylococcus aureus) that gets into the nail fold. Sometimes it can be from a yeast, like Candida. Either way, the skin of your nail folds becomes red and inflamed.

With paronychia, the nail fold might get red, swollen, and be painful. Sometimes, a little pocket of pus called an abscess might form.

Most cases of bacterial paronychia will get better in less than a week once you start treating it. Sometimes, paronychia caused by yeast can last for 6 weeks or more.

What does paronychia look like?

Dr. Rx

If there are painful blisters (white, clear, fluid-filled bubbles) on the skin surrounding the nail that keep recurring, it may be a herpes virus skin infection called whitlow. If there is a red, bleeding bump in the nail fold, this may be a pyogenic granuloma—a non-cancerous growth made of blood vessels. Both should be treated by a doctor. —Dr. Lauren Levy

Usually, the nail fold located on the edge or bottom of the fingernail or toenail becomes inflamed.

Inflammation makes the skin swollen, red, and very painful. It might fill with pus, look yellow or white, or feel like it’s full of fluid.

If you get paronychia infections often, you might lose your cuticle (the transparent skin located above and around the bottom nail fold). This causes the hard portion of the nail (known as the nail plate) to lift from the surrounding skin.

The nail may fall off after the infection, but it usually grows back once the infection is under control. If the infection is chronic, the nail itself might become thicker, discolored, or brittle.

Main symptoms

• Swelling of nail folds
• Redness
• Pain
• Pus-filled abscesses
• Nail changes including: thickening, discoloration, and brittleness
• Loss of cuticle

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Causes of paronychia

The nail infection happens when bacteria or yeast enter the skin around the nail through an opening. That can be caused by trauma to the nail (like aggressive cutting of the cuticles or skin around the nails) or through some kind of tear or cut.  It can also happen if your skin is often wet from a job like dishwashing. The common types of infection are:

Bacterial is the most common cause of paronychia.

Bacterial paronychia usually causes an abscess around the nail, redness, and pain. The bacteria can enter the nail through a cut in the skin or from a dirty manicure tool. The types of bacteria that cause this infection are

• Staphylococcus aureus (“staph”) is the most common infection.
• MRSA (methicillin-resistant staph aureus) is a type of staph that may need special antibiotics.
• Streptococcus.
• Pseudomonas.

Yeast usually causes a paronychia that is more chronic with redness and scaling around the entire finger nail.

• Candida is usually the cause.
• You are less likely to have an abscess.
• Chronic wet hands can make you susceptible to this condition.
• More likely to be a yeast infection if it lasts for 6 weeks or longer.

How do you treat paronychia?

Paronychia can be painful and needs to be treated. If you don’t treat it, your whole nail fold can become infected and you can lose the nail.

In the worst case, the infection can spread through the blood or to the bone in the finger (osteomyelitis). This can cause a more serious infection that could require surgery.

If you think you have a nail infection, see your doctor or a dermatologist or go to an urgent care center. The doctor will take your medical history and do a physical exam to see if there is a pocket of pus. They may ask you about your profession or the frequency of manicures. You probably won’t need blood tests to diagnose paronychia.

Bacterial paronychia treatment

If you have a pocket of fluid, your doctor will cut and drain the wound (called incision and drainage—or “I&D”). They will first give you something to numb the finger, like a lidocaine injection.

After it’s drained, they’ll squirt saline solution into the wound to clean it and will pack it with gauze. Your doctor may take a swab of the pus (a culture) and send it to the lab to identify what kind of bacteria or yeast caused the infection.

After the drainage, you will need to soak your finger or toe in warm water for 10 to 15 minutes, 3 times a day, until the infection is gone. Soaking is also how you treat the infection if you don’t need it to be drained.

Your doctor might give you antibiotics, topical (to apply directly to the nail bed), or oral. It depends on how bad the infection is. Take the entire course, even if symptoms go away.

Medications

• Topical antibiotics: These include over-the-counter ointments like triple ointment (Neosporin) and bacitracin, or prescription medications like mupirocin.
• There are several oral antibiotics your doctor can prescribe depending on the type of infection.

Yeast paronychia treatment

If there is no pocket of pus, but chronic redness around the nail, your doctor will recommend the use of an antifungal cream to be applied to the nail. Your doctor may ask you to wear gloves while working with water like when washing dishes.

Medications

• Topical antifungals, like clotrimazole or ketoconazole cream.

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Risk factors

• People with weakened immune systems, such as those with HIV, diabetes, or those taking drugs that affect the immune system (immunosuppressives), are at increased risk.
• Those working as dishwashers, bartenders, or housekeepers may be at a higher risk.
• Manicures and pedicures can also put you at risk.
• Ingrown finger or toe nails increase the risk of infection.

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Children and paronychia

Children are just as likely as adults to get nail infections. Sometimes, childhood behaviors like thumb-sucking or nail-biting can create the infection. If you think your child has it, take them to see their pediatrician. The doctor may cut open the pus pocket and may give your child antibiotics like Clinidamycin or amoxicillin-clavulanate (Augmentin).

Pro Tip

It is not contagious. You can change your child’s diaper or hold your loved one’s hand. However, you may want to bandage the area to prevent oozing or leakage. —Dr. Levy

Follow up

A bacterial infection should start to improve within 24 to 48 hours of treatment. If it doesn’t, call your doctor.

Yeast paronychia will start to improve within a few days but may take up to 6 weeks. You should follow up with your doctor in 6 to 8 weeks to check for improvement.

Preventative tips

Pro Tip

Over trimming the nail cuticle can predispose you to paronychia. The cuticle protects us from infection. I usually recommend pushing back the cuticles rather than cutting them. —Dr. Levy

• Keep your hands dry and wear gloves while doing any wet work.
• Don’t suck your thumb or bite your nails.
• Wash your hands thoroughly.
• Clean and bandage cuts and scrapes around the nails.
• Make sure all manicure tools are clean and sterile.

This is a treatable condition. It will get better with simple treatments and behavioral changes like the way you cut your nails (preventing the nail from going into the fold) or wearing gloves when exposing your hands to water.

Lauren Levy, MD, FAAD.

Clinical Instructor , Mount Sinai Hospital, Department of Dermatology

Dr. Levy is a board certified dermatologist specializing in medical derm with expertise in acne, rosacea, skin cancer, psoriasis, and skin manifestations of rheumatologic disease. Her undergraduate education was completed at the University of Pennsylvania where she graduated summa cum laude and was inducted into the Phi Beta Kappa honors society. She graduated with a distinction in research from t…

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causes, symptoms, diagnosis and treatment

Diabetes mellitus

Ingrown toenail

Paronychia

Pandactylite

16108

23 December

Panaritium: causes, symptoms, diagnosis and treatment.

Definition

Panaritium is an acute purulent inflammation of the tissues of the fingers of the upper and, less commonly, lower extremities. The disease is considered one of the most common in purulent surgery and accounts for up to 46% of all cases requiring surgical treatment in a polyclinic.

Causes of panaritium

Panaritium can be formed as a result of visible or imperceptible microtrauma. In 33% of cases, small stab wounds and splinters are responsible for the development of inflammation, in 25% – abrasions and small scratches. The cause of panaritium can be injuries received during a manicure or injection, burrs, an ingrown nail (due to the peculiarities of its anatomical structure or improper cutting).

Some chemicals, getting on the skin of the fingers, have a toxic effect on it, creating conditions for the penetration of infectious agents. Bacteria penetrate through the damaged skin of the finger, which cause a purulent-inflammatory process – most often we are talking about Staphylococcus aureus, less often – about Streptococcus, Escherichia coli, Proteus. The microflora in the purulent focus can be represented by microbial associations of three or more microorganisms.

Type 2 diabetes mellitus, beriberi, and circulatory disorders predispose to the occurrence of panaritium.

Classification of the disease

There are superficial and deep forms of panaritium.

Surface forms:

• dermal panaritium,
• subcutaneous felon,
• subungual felon,
• panaritium of the periungual roller.

Deep panaritium:

• bone panaritium (acute and chronic),
• tendinous panaritium,
• articular felon,
• osteoarticular panaritium,
• pandactylitis.

According to the stages of the development of the disease, serous and purulent stages are distinguished. The serous stage is reversible and can be stopped by conservative methods – drug therapy, dressings, physiotherapy. It is characterized by swelling, redness, and pain. At the purulent stage, there is a pronounced inflammation due to the formation of a purulent focus. This stage requires surgical treatment.

Symptoms of panaritium

The main symptom of the disease is always intense throbbing pain. Sometimes the pain intensifies at night and deprives the patient of sleep, it is a sign of the need for urgent medical attention and, possibly, surgery.

The abscess can spontaneously open, in which case the pain syndrome subsides, which creates a false impression of an improvement in the condition.

The pain is accompanied by swelling of the soft tissues and redness, but with deep felons, redness may be absent or insignificant. As the inflammatory process develops, movement in the finger is limited, especially in deep forms with damage to the joints or tendons. The patient may experience fever, weakness, malaise.

Skin felon is considered the mildest form of the disease. A purulent focus is formed in the thickness of the skin, under the epidermis, while the rest of the tissues are not affected. The resulting serous, serous-hemorrhagic or purulent exudate leads to detachment of the epidermis and the formation of a bubble. About 80% of cases of cutaneous panaritium are recorded on the palmar surface of the fingers.

One of the most common forms of the disease is subcutaneous felon, which is manifested by an inflammatory process in the subcutaneous adipose tissue. At 80-90% of cases, the process is localized on the palmar surface of the distal phalanx, more often I, II and III fingers. Inflammation of the fiber causes swelling, which compresses the vessels and causes severe throbbing pain.

The affected phalanx becomes red, swollen, hot. In this form, the temperature can rise up to 38°C.

With subungual panaritium, inflammation develops under the nail plate as a result of injury or a splinter getting under the nail. The patient experiences constant arching pain, aggravated by pressure on the nail, the finger swells, becomes hot. The accumulated purulent exudate can exfoliate the nail. Possible increase in body temperature.

Paronychia is an inflammation of the periungual fold that occurs when it is damaged. The roller becomes edematous, hyperemic, pus accumulates under the nail roller and can shine through the skin.

Tendon panaritium (purulent tendovaginitis) is a deep, severe form of inflammatory process, which most often develops as a result of late or ineffective treatment of subcutaneous panaritium or as a result of trauma. With tendon panaritium, patients note intense jerking and arching pain along the entire tendon, aggravated by flexion and extension of the finger, passive movements are severely limited. The finger can be in a forced half-bent position and swell throughout, sometimes inflammation passes to the hand and forearm.

Articular panaritium occurs as a result of the progression of subcutaneous and tendon panaritium, as well as as a result of trauma to the back of the finger with primary damage to the capsule of the interphalangeal joint. With articular panaritium, interphalangeal or metacarpophalangeal joints become inflamed, in which inflammatory exudate accumulates. As a result, the finger acquires a flask-shaped or spindle-shaped appearance with a maximum volume in the joint area. The skin over the joint becomes smooth, shiny and hyperemic. The pain intensifies when trying to make any movement. The long course of the disease is fraught with the destruction of articular cartilage and the spread of the process to bone tissue.

Bone panaritium is an inflammatory process that occurs in the bones of the fingers. It occurs as a result of the transition of infection from surrounding tissues to the bone or as a result of extensive trauma. Bone panaritium is characterized by bursting, throbbing pain. When the process is localized on the nail phalanx, edema occurs, and the phalanx becomes like a flask. The skin is strongly hyperemic, hot. There are signs of general intoxication: fever, chills, headache, weakness. The formation of a purulent fistula indicates the development of chronic panaritium.

The most severe purulent pathology of the finger is pandactylitis. It is characterized by damage to all anatomical structures of the finger (skin, fiber, tendons, bones and joints) and extends to at least two phalanges.

Pandactylitis is most often seen as a result of late/insufficient treatment of other forms of panaritium or as a result of extensive trauma to the finger. Throughout the inflammation, swelling is observed, the finger is sharply thickened, has a purple-blue color, very painful, active and passive movements are impossible. Often multiple fistulas are formed, from which purulent discharge oozes. The finger takes a forced half-bent position. General intoxication is observed, regional lymph nodes are enlarged and painful. With this form, the risk of losing the phalanx or the entire finger is very high.

Diagnosis of panaritium

Panaritium can be diagnosed by a doctor on the basis of a clinical examination. Recommended examinations:

• complete blood count;

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
Brief description of the study CBC: general a…

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Glucose (in the blood) (Glucose)

Research material

Serum or blood plasma. If it is not possible to centrifuge the sample 30 minutes after collection for serum/plasma separation…

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Culture of wound exudates and tissues for microflora and determination of sensitivity to an extended spectrum of antimicrobials

Synonyms:
Wound/tissue Culture. Aerobic Bacteria Identification and Antibiotic Susceptibility extended testing.
Brief description of the study “Sowing wound discharge and tissues for microflora and determination …

Up to 7 business days

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X-ray of the bones of the hand

X-ray examination of the bones of the hand is intended for the diagnosis of traumatic injuries, pathological changes, as well as the assessment of bone development …

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X-ray of the bones of the foot

X-ray examination of the foot in two projections allows diagnosing injuries and other pathological changes, including flat feet.

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X-ray signs may lag behind the clinical ones, so it is recommended to repeat the x-ray in 1-2 weeks.

• In case of severe intoxication syndrome, an electrocardiographic study is performed

ECG with interpretation (ECG with interpretation)

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Which doctors to contact

surgeon.

In the presence of bone tissue destruction, a consultation with a traumatologist is recommended. If a patient with panaritium has diabetes mellitus, then consultation is required.
endocrinologist.

Treatment of panaritium

Panaritium is treated surgically. The amount of intervention depends on the type of panaritium. The general principles of surgical treatment of panaritium include opening the abscess, removing purulent-necrotic masses, thorough cleansing (sanation) and installing drains. Antibiotic therapy is mandatory.

In the cutaneous form, it is enough to incise the skin and evacuate the contents, and apply a bandage with an antibacterial ointment to the bottom of the wound.

With subcutaneous panaritium in the serous stage, conservative management is possible, but the first sleepless night spent by the patient is considered an absolute indication for surgery – severe throbbing pain that prevents sleep is evidence of suppuration.

With the development of subungual panaritium, part of the affected nail or the entire nail is removed. Paronychia can be treated conservatively, but when pus appears, only surgery is effective.

Tendon panaritium is treated urgently, as compression of the tendon by exudate quickly leads to tendon necrosis. The area of ​​inflammation is opened in order to evacuate the exudate, the tendon sheath is washed with an antiseptic solution.

Treatment of articular felon requires arthrotomy – opening the joint cavity with subsequent evacuation of the contents and drainage. If the articular surfaces are already destroyed, resection of the destroyed articular parts of the bone is performed. In rare cases, amputation of the finger is necessary.

In the initial stages of osteoarticular and bone panaritium, conservative therapy is allowed, but if there is no improvement within 1-2 days, surgery is required.
With pandactylitis, necrotic tissues are removed, even finger amputation or exarticulation (removal of the peripheral part of the finger along the joint) is possible.

Complications

A formidable complication of panaritium is the development of phlegmon of the hand – an acute diffuse purulent inflammation of the deep or superficial tissues of the hand, which spreads rapidly and does not tend to limit. For example, there is a high risk of developing phlegmon with tendon felons of the I and V fingers, since the tendon sheaths of these fingers extend to the wrist and forearm and are connected with the cellular spaces of the forearm.

Severe purulent inflammation of the finger, such as pandactylitis, can lead to the loss of part of the finger or its complete amputation.

Bone panaritium is dangerous for the development of chronic osteomyelitis, accompanied by partial or complete loss of finger mobility.

Prevention of panaritium

For preventive purposes, it is necessary to treat any microtrauma of the fingers. This treatment should also be aimed at preventing the development of infection in the wound.

Even a small wound must be treated in a timely and thorough manner and closed for a short time with a bactericidal plaster to protect the injured area.

Manicure and pedicure should be performed only with sterilized instruments, skin damage should be avoided, and if they occur, immediately treated with an antiseptic.

Sources:

1. Purulent diseases of the hand, bones and joints: textbook / V.S. Panteleev, M.A. Nartailakov, M.R. Garaev. – Ufa: FGBOU VO BSMU of the Ministry of Health of Russia, 2021. – 74 p.
2. Purulent-inflammatory diseases of the fingers and toes (introduction to the problem) / A.G. Sonis, E.A. Stolyarov, D.G. Alekseev, M.A. Bezrukova // Moscow surgical journal. – 2020. – No. 1 (71). – pp. 62-69.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Panaritium

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Felon

Panaritium is a purulent inflammation of the soft tissues and bones of the finger. Depending on the localization of the purulent focus and the depth of the inflammatory process, skin, subcutaneous, subungual, articular, tendon, bone panaritium, pandactylitis and paronychia are distinguished.

Cutaneous panaritium is an abscess located under the epidermis of the skin. In the case of panaritium of the nail, depending on the location and distribution, three forms are distinguished: paronychia and subungual panaritium. Paronychia is a purulent inflammation of the roller surrounding the nail. Subungual panaritium is a collection of pus under the nail. Subcutaneous felon is a purulent inflammation of the subcutaneous tissue of the phalanges of the fingers. The favorite localization of the subcutaneous panaritium is the palmar side of the terminal phalanx of the finger. Tendon panaritium is the most severe and disabling form of purulent inflammation of the fingers, which is accompanied by damage to the tendon sheath and death of the tendon of the finger. Bone and articular panaritium occurs primarily with a deep wound to the bone and joint cavity or when inflammation passes from the surrounding tissues as a complication of subcutaneous panaritium. In the case when purulent inflammation covers the entire thickness of the finger, they speak of pandactylitis.

Causes of panaritium

Any panaritium is caused by a visible or unnoticed microtrauma: a prick, a scratch, a foreign body (for example, a splinter, glass wool, glass, metal shavings, etc.), abrasion, wounds during manicure.

The causative agent of the disease penetrates through the resulting skin lesions. Panaritium is caused by bacteria, primarily Staphylococcus aureus, as well as streptococci and enterococci. Less commonly, purulent inflammation develops with the participation of Escherichia and Pseudomonas aeruginosa, Proteus.

Predisposing factors for the development of panaritium are diabetes mellitus, impaired blood supply to the hand, vitamin deficiency and immunodeficiency. In such cases, the purulent process develops faster, is more difficult and difficult to treat.

The specificity of panaritium symptoms and the nature of the course of the purulent process are due to the peculiar anatomy of the fingers. The fact is that the skin of the palmar surface of the fingers is tightly fixed to the underlying structures and bones by dense connective tissue septa, which form a large number of closed cells with subcutaneous fat. Subcutaneous fat is a favorable environment for the reproduction of microorganisms. Therefore, when the skin is damaged and such a cell with a nutrient medium is infected, the purulent process does not spread along the finger, but in depth towards the tendon and bone. That is why bursting and shooting pains in the finger early. The skin of the back surface of the fingers, on the contrary, is loosely connected with the underlying structures, therefore, edema develops more easily on the back of the finger, often distracting from the main cause of the disease.

Symptoms of panaritium

Depending on the type of felon, clinical manifestations will be different.

Intradermal felon proceeds most easily. It looks like a bubble filled with pus, located most often on the palmar surface of the terminal phalanx. Disturbed by moderate pain and a feeling of fullness in the area of ​​the bladder.

Manicure paronychia is an inflammation of the nail fold that becomes swollen, red and painful. With continued inflammation, the skin of the roller rises, becomes whitish – pus shines through it. Pain in paronychia varies from aching to constant, throbbing in the stage of abscess formation. Pus can spread under the nail plate with the formation of a subungual panaritium, the main symptom of which will be the exfoliation of part or all of the nail plate with pus.

Subcutaneous panaritium is accompanied by a thickening of the affected phalanx of the finger, the skin turns red, shiny. Movements in full become impossible due to pains of a pulsating nature, which intensify when lowering the arm.

With tendinous panaritium, there is a thickening and redness of the entire finger, movements are sharply painful. The finger becomes sausage-shaped, is in a half-bent state. Pains are expressed, pulsing character. Edema may spread to the back of the hand and the palmar surface. The purulent process progresses quite quickly, spreading after the edema to the hand and even the forearm. Typical symptoms of tendon panaritium are shown in the photo below.

In articular and bone panaritium, the joint and bone of the phalanx of the finger are involved in the purulent process. Symptoms of bone and articular panaritium are similar to those of subcutaneous panaritium, but more pronounced. The swelling usually spreads throughout the finger. The pains are strong, intense and are not subject to clear localization, the finger is bent, movements are impossible due to pain and swelling. Spontaneous breakthrough of pus through the skin is possible with the formation of purulent fistulas. In the case of articular panaritium, initially swelling, redness and pain are localized around the affected joint, but if left untreated, they spread to the entire finger. A typical clinical picture is shown in the photo.

Examination with panaritium

If you experience these symptoms, you should contact your polyclinic surgeon. In the case of paronychia, cutaneous and subcutaneous felon, the diagnosis is made on the basis of the clinical picture and does not require additional instrumental examination. It is enough to pass a general blood test and blood glucose to determine the severity of the inflammatory process and the diagnosis of diabetes mellitus, and if present, the severity of the course of the disease. In case of suspicion of bone and articular panaritium, as well as tendon panaritium (to exclude the involvement of the bone in the inflammatory process), it is necessary to perform an x-ray of the hand. You should know that the x-ray picture lags behind the clinical picture by 1 to 2 weeks. Therefore, the radiography should be repeated after a specified period of time.

Treatment of panaritium

At the initial stages of the development of the inflammatory process, conservative treatment is possible in the form of antibiotic therapy, baths with hypertonic salt solution and physiotherapy procedures. However, patients often skip this stage of inflammation and do not seek medical help.

Purulent process in the finger usually develops on the 3rd day after infection. This is evidenced by constant throbbing pain and an increase in body temperature above 37 ° C. The first sleepless night due to pain is an indication for surgical treatment.

In case of cutaneous panaritium, the operation consists in excision of the epidermal vesicle at the border with healthy skin, treatment with 3% hydrogen peroxide solution and brilliant green. This manipulation can be performed at home with sharp nail scissors, after leaving them for 10 minutes in 70% ethyl alcohol for sterilization. The procedure is completely painless and does not require anesthesia. However, there is a danger of the existence of a panaritium in the form of a cufflink, when there is a fistulous opening in the bottom of the bladder that goes under the skin. In this case, along with the skin panaritium, there is also a subcutaneous panaritium. Therefore, excision of the exfoliated epidermis without surgical treatment of subcutaneous felon for recovery will obviously not be enough, which will lead to the progression of purulent inflammation.

In case of paronychia, the resulting abscess is opened by lifting the skin roller at the base of the nail. If pus penetrates under the nail, then its exfoliated part is removed.

In case of subcutaneous panaritium, 2 lateral incisions are made on the border with the palmar surface of the skin, through which through drainage is carried out in the form of gauze turunda and a rubber graduate. They prevent the edges of the postoperative wound from sticking together, which is necessary for adequate outflow of pus and washing of the purulent cavity during dressings.

Paronychia, cutaneous and subcutaneous panaritium are treated in outpatient settings. When confirming the diagnosis of tendon, bone and articular panaritium, treatment is necessary in the conditions of the department of purulent surgical infection.

At the initial stage, a partial treatment of the purulent focus is performed, as in subcutaneous panaritium. In the future, individual treatment is carried out.

Antibacterial therapy of panaritium on an outpatient basis is reduced to taking drugs such as ciprolet 500 mg 2 times a day for 7 days or amoxiclav 625 mg 3 times a day for 7 days.

Prevention of panaritium

To prevent the development of panaritium, it is very important to properly treat the resulting wound of the hand in a timely manner. When receiving a microtrauma of the hand, you should wash your hands with soap and water, remove foreign bodies from the wound (splinter, metal shavings, glass, and so on), squeeze a drop of blood from the wound, treat with a 3% hydrogen peroxide solution, grease the edges of the wound with an alcohol solution of iodine or brilliant green. Seal with a bactericidal plaster or sterile napkin.

When performing a manicure, skin damage should be avoided; before the procedure, treat the cuticle and adjacent skin with 70% alcohol. Manicure tweezers should also be immersed in 70% ethyl alcohol for 5-10 minutes. If the skin is damaged, it should be treated with ethyl alcohol and avoid contamination with earth, when cutting meat, and so on.

Complications of panaritium

When panaritium is started, inflammation may move to deeper tissues with the development of pandactylitis. The latter is difficult to treat and often results in finger amputation. The transition of purulent inflammation to the tendon and the lack of timely surgical treatment causes tendon necrosis with the loss of active movements in the finger. In the tendon sheath, the purulent process quickly spreads to the hand with the development of phlegmon of the hand, the treatment of which requires extensive surgical interventions.