Paronychial Infections



Paronychial Infections


Timothy P. Crowley

Susan Stevenson



INTRODUCTION



  • Pathoanatomy



    • A paronychia is an infection of the soft tissue structures surrounding the proximal and lateral nail plate (perionychium).


    • The proximal nail fold (eponychium) and lateral nail folds (paronychium) normally provide a watertight seal around the border of the nail plate.


  • Mechanism



    • A paronychia develops with the introduction of microbes between the nail plate and the surrounding perionychium. This is often as a result of minor trauma that disrupts the seal between the nail plate and the nail folds. Commonly this is secondary to a hangnail, nail biting, or instrumentation of the perionychium following manicure.


    • Inflammation of the nail fold with erythema, pain, and swelling may progress to abscess formation.


    • If untreated, the abscess can spread and separate the nail plate from the nail bed or it can extend volarly into the pulp space of the finger tip.


    • Chronic paronychia occurs when repeated episodes of inflammation and drainage result in separation of the nail plate and the dorsal soft tissues of the nail fold. Chronic inflammation leads to thickening of the nail fold with resultant reduction in blood flow and thus susceptibility to recurrent episodes of infection (J Hand Surg Am 1991;16:314-317).


  • Epidemiology



    • Paronychial infection is the most commonly seen hand infection.


    • Mixed bacterial infections are commonly seen, with Staphylococcus aureus the most frequently implicated organism.


    • Anaerobic infections are also seen, possibly due to contamination of the initial wound with the oral cavity (J Hand Surg 1993; 18:358-359 & Br J Surg 1981;68:420).


    • Chronic paronychia is often associated with more atypical bacteria, including Gram-negative organisms, mycobacterial
      species, and fungal infections primarily Candida (J Hand Surg 1993; 18:358-359 & J Clin Microbiol 1988;26:950-953).


EVALUATION

May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Paronychial Infections
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