Acute paronychia L03.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

acute paronychia; Acute paronychia; Circulation; felonious nailwall inflammation; Finger Circulation; Nail crease inflammation; Painful whitlow; Panaritium paraunguale; Panaritium subunguale; purulent nail crease

Definition
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Frequent, acute, mostly bacterial, after banal trauma induced nail fold inflammation with reddened, swollen, painful nail fold (paronychium, see nail below).

Pathogen
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Staphylococcus aureus, streptococci, Pseudomonas aeruginosa, Proteus mirabilis, yeasts (Candida albicans). Rare herpes simplex viruses.

Etiopathogenesis
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  • Acute paronychia is mostly infectious caused by pyogenic cocci (rarely as syphilitic paronychia).
  • If the course of the disease is recurrent, an infection by the herpes simplex virus must also be considered.

Manifestation
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Children and young people, also adults.

Herpes simplex virus-induced loco recurrent paronychia occurs predominantly in adults and is often combined with genital herpes simplex infection.

Clinical features
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Inflammatory reddened, swollen, painful nail fold with emptying of pus droplets under pressure. Painful onycholysis is not uncommon.

Therapy
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For purulent paronychia: soap baths, lukewarm 5-10 minutes, preferably with curd soap, but also liquid soaps (bath water should appear milky cloudy). Otherwise lukewarm baths with disinfectant additives such as quinolinol (e.g. Chinosol 1:1000 or R042 ) or potassium permanganate (light pink). Antisepsis with polyvidon-iodine ointment dressings (e.g. R204, Braunovidone-iodine ointment) or dressings with sodium bituminosulfonate (e.g. Ichtholan special ointment, Ichthoseptal cream). Immobilizing the finger with a Böhler splint. In case of resistance to therapy, nail extraction in LA is recommended. The infection heals promptly under this procedure.

In the case of extensive findings and/or progression of the inflammation under external therapy, antibiotic systemic therapy after antibiogram. Initial cephalosporins such as cefuroxime (e.g. Elobact) 2 times/day 500 mg p.o. or gyrase inhibitors such as Ofloxacin (e.g. Tavanic 200 mg/day p.o.).

Afterwards skin care: Desiccated nail folds should be regularly treated with an O/W emulsion (e.g. Unguentum emulsificans aquosum preparation saturated with vegetable oils).

General therapy
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Eliminate or change predisposing factors if possible, such as sicca symptoms in atopic eczema, diabetes mellitus, acrocyanosis, hyperhidrosis Discontinue causative medication, e.g. retinoids. If necessary, change professions in baking, nursing, etc.

Note(s)
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The superficial vesicular form of acute paronychia is a special form of bullous impetigo which is characterized by the topography. It is also known as bulla repens (or bulla roden or circulation). Deeper abscessed paronychia are generally called panaritium.

General information on prophylaxis:

  • Regular prophylactic hand disinfection (e.g. with disinfectant spirit (NRF 11.27.)
  • No cutting of the cuticle.
  • Keep nails short.
  • Do not cut toenails round.
  • In case of nail wall injuries, consistent antiseptic local therapy, e.g. with Polyvidon Iodine Ointment R204.

Remember! In case of chronic paronychia think of Unguis incarnatus!

Literature
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  1. Chanprapaph K et al (2014) Epidermal growth factor receptor inhibitors: a review of cutaneous adverse events and management. Dermatol Res Pract doi: 10.1155/2014/734249
  2. Di Costanzo L et al (2014) Acrodermatitis continua of Hallopeau (ACH): two cases successfully treated with adalimumab. J Dermatologist Treat 25:489-494
  3. Iorizzo M (2015) Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin 33:175-183
  4. Shafritz AB et al (2014) Acute and chronic paronychia of the hand. J Am AcadOrthop Surg 22: 165-174

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020