Visual Diagnosis

Case: A boy presents to the ED with a swollen and painful thumb for 3 days. He denies any trauma to area, but admits to biting his nails.

Diagnosis:

This patient has paronychia.

Paronychia is an infection often caused by bacteria or fungus near the nail cuticle. The affected area is often swollen, red, and inflamed, and may progress to fluctuant purulence at the nail plate. Trauma to the nail bed (such as nail biting or skin picking) introduces pathogens to the fingertip. Topical or oral antibiotics may treat early paronychia. Incision and drainage is the preferred treatment for infections with abscess.

Clinical Practice Pearls:

• Use a #11 blade scalpel with a sharp tip to drain abscesses.
• A topical anesthetic or a digital block may alleviate pain during abscess draining.
• Consider fungal infections for chronic paronychia.

Futher Reading:

• Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014. 22(3):165-174.