Acute Paronychia

Diagnosis: Acute Paronychia

The lateral fold appears erythematous and swollen with collection of pus under the skin.

Clinical Presentation

The lateral fold appears erythematous and swollen with collection of pus under the skin.

Clinical History

Submitted by Alaa Saad. Originally posted January 18, 2011.

Treatment

See case discussion.

Differential Diagnosis

• Herpetic whitlow • Chronic paronychia • Felon (pulp space infection) • Cellulitis • Psoriatic nail disease • Subungual melanoma (amelanotic)

Key Learnings

• Acute bacterial infection of nail fold — most commonly S. aureus • Often follows trauma: nail biting, hangnail, manicure, splinter • Herpetic whitlow must be distinguished — grouped vesicles, viral prodrome, do NOT I&D • Early: warm soaks, topical antibiotics. Fluctuant abscess: I&D • Recurrent episodes may indicate underlying chronic paronychia or Candida

Tags: acute, paronychia, alaa saad