Paronychia
- 2. Nail anatomy Nail plate (body): * is the clear, firm & translucent portion, (hard keratin) * is created by the nail matrix * is bordered by proximal & lateral folds
- 3. Nail anatomy Nail matrix : directly below the cuticle. * produces the nail plate. * contains blood vessels and nerves. * If the matrix is damaged the nail will grow deformed
- 4. Nail anatomy Lunula : is the crescent shaped whitish area of the nail bed Cuticle or (Eponychium): skin fold at the proximal end of the nail Nail fold : hard skin overlapping the base & sides of the nail Nail bed : is continuation of the matrix & the the nail plate rests on Hyponychium: is under the free edge of the nail plate
- 5. Paronychia • It is a soft tissue infection around a fingernail • It is the most common hand infection • Occurs in the subcuticular area under the eponychium
- 6. Acute paronychia • Minor injury to the finger is the common cause (nail biting) • nail biting breaks down the physical barrier between the nail bed and the nail allowing the infiltration of infectious organisms • Organisms – staph.aureus & strep.pyogenes • It tracks around the skin margin – spreads under the nail causing floating nail or hang nail
- 7. Acute paronychia Clinical features : • Edema, erythema andsevere THROBBING pain along the lateral edge of the nail fold. • Nail on touch is very tender • May have extension to the proximal nail edge. • Presence of frank abscess and fluctuation • Subungual abscess ( floating nail ) if pus has extended under the nail plate.
- 9. Acute paronychia • Treatment : • Pus is drained by making an incision over eponychium • Pus is sent for c/s • Antibiotics like cloxacillin,amoxycillin • Floating nail – indicates that nail is dead – excision of nail is done
- 10. Acute paronychia • Surgical treatment – pus drained by making incision over eponychium
- 11. Chronic paronychia • Symptoms present for 6 weeks or longer • Caused by Candida. Albicans • Secondary bacterial infection may supervene • Can be a complication of eczema • In housekeepers, dishwashers, and swimmers
- 12. Chronic paronychia • Clinical features : • Itching in nail bed • Recurrent pain • Discharge The nail folds are swollen, erythematous, and tender with pronounced transverse ridges
- 14. Chronic paronychia • Management : • Culture of scrapings for fungus and other causative agents . • Long term anti fungal therapy • Antibiotics – if bacterial infection supervenes • In severe cases – removal of nail
- 15. Subungual hematoma • Collection of blood in the space between the nailbed and fingernail. • The pressure generated by this collection of blood under the nail causes intense pain.
- 16. Subungual hematoma • Etiology : • They occur most commonly due to a crush type injury to the tip of the finger or toe. This injury can occur in many ways: • Hitting your finger with a hammer • Dropping a heavy object on your toe • Closing your finger in a door
- 17. Subungual hematoma • Clinical features : • The most common symptom is intense pain. • Pressure generated between the nail and the nailbed, where the blood collects, causes this pain. • You will have a discoloration of red, maroon, or other dark color beneath the nail after an injury.
- 18. Subungual hematoma Management : • Ice, limb elevation, and anti-inflammatory medications, such as ibuprofen, are recommended for minor hematomas • If the hematoma is 25% or more of the underlying nail area, then medical attention is required. • x-ray is taken to look for the possibility of a fracture
- 19. Subungual hematoma • Management : • Cautery: A battery-operated device is used to burn a hole in the nail until the blood is reached and drains out the hole. • Needle: A large diameter needle is used to drill or bore into the nail to create a hole to allow the blood to drain out.