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You are seeing an 8 year old male with 3 days of progressively worsening redness, tenderness, and swelling of his right index finger proximal lateral nail fold and adjacent skin. The central portion of the swollen area shows a small amount of subcutaneous purulent fluid. He is right-hand dominant, otherwise healthy, and is afebrile. He admits to having a habit of biting his fingernails.
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October 19, 2022 at 10:02 pm
E) All of the above
The patient has a paronychia, which is an infection of the proximal or lateral nail folds. Minor trauma such as from manicures, nail biting, thumbsucking, or picking at hangnails is a predisposing factor. Skin flora such as Staph. aureus and Strep. pyogenes are common infectious agents. Early on, the infection may not be abscessed. At this time, treatment with warm water soaks multiple times a day and topical mupirocin may suffice. Ibuprofen can be used for analgesia and anti-inflammatory effect. If the infection progresses despite this, oral anti-staphylococcal antibiotics such as cephalexin, amoxicillin-clavulanate, or dicloxacillin are indicated. If MRSA is suspected, TMP-SMX, clindamycin, or doxycycline can be used. Once abscessed, incision and drainage if performed by inserting an 11-blade under the cuticle margin, with the blade parallel to the nail itself.