Figure

Acute bacterial paronychia.

Figure 5.2

Acute bacterial paronychia—pus tracking within the lateral nail fold.

Figure 5.2

Acute bacterial paronychia—pus tracking within the lateral nail fold.

Distal subungual pyogenic infection may or may not be secondary to the periungual varieties. Treatment is by excision of a U-shaped piece of the distal nail plate in the region loosened by the pus and debridement of the affected nail bed. Extension of the infection may involve the finger pulp or the matrix. Sometimes the evacuation of a perionychial phlyctenular abscess uncovers a narrow sinus; this may be part of a 'collar-stud' abscess which communicates with a deeper, necrotic zone; it must be exposed and excised. If acute paronychia accompanies ingrowing nail, the treatment must be supplemented by removing all offending portions of the nail plate. After surgery, the dressing is kept moist with saline or an antiseptic soak. This should be changed daily after bathing in antiseptic soap until the purulent discharge stops—preferably with full splinting and immobilization of finger, hand and forearm.

In general, acute paronychia involves only one nail. In chronic or subacute paronychia, which may mimic acute paronychia, several finger nails may be infected. The differential diagnosis includes:

• paronychial inflammation of the finger nails accompanying chronic eczema

• psoriasis and Reiter's disease, which may also involve the proximal nail fold

• acute ischaemia where the finger is cold.

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