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What´S Acute Paronychia? Essay

846 words - 4 pages

The nail is a complex cutaneous structure that consists mainly of the nail matrix, nail plate, nail bed, cuticle (eponychium), and nail folds. The cuticle is an outgrowth of the proximal fold, which is situated between the skin of the digit and the nail plate, providing a waterproof seal from external irritants and pathogens.

Paronychia is as an inflammatory reaction of one or more of the three nail folds, proximal or lateral ones, surrounding finger- or toe-nails. It is most commonly divided into acute and chronic. Acute paronychia lasts by definition less than six weeks and is usually associated with inflammation following minor trauma, while chronic paronychia lasts more than six weeks ...view middle of the document...

Patients may initially present with only superficial infection and accumulation of purulent material under the nail fold but an untreated infection may lead to a subungual abscess, with inflammation of the nail matrix and a consequent dystrophy of the nail plate. Pus formation can proximally separate the nail from its underlying attachment, causing elevation of the nail plate. Recurrent acute paronychia may result into chronic paronychia.

The diagnosis of acute paronychia is based on a history of trauma and findings on physical examination of nail folds. The digital pressure test may cause blanching of the overlying skin and clear demarcation of the abscess, by applying light pressure to the distal volar aspect of the affected digit. In case of severe infection or abscess, cultures should be obtained to identify the responsible pathogen and to exclude methicillin- resistant S. aureus (MRSA) infection.13

Other causes of acute paronychia or other medical conditions that may involve the proximal nail fold and mimic acute paronychia include psoriasis, Reiter syndrome and herpetic whitlow.10 Herpetic whitlow typically appears as recurrent single or grouped blisters with a honeycomb appearance and occurs in health care professionals and healthy children, as a result of topical inoculation.12,8 Diagnosis can be confirmed by Tzanck testing or viral culture.

Treatment of acute paronychia may be either topical or systemic. If the degree of inflammation12 is not excessive and an abscess has not been formed, the topical use of warm water compresses or Burow’s solution (i.e. aluminum acetate)10 or vinegar may be effective.5,11 The use an antibiotic cream (e.g....

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