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A simple surgical procedure is presented which has been effective in curing the troublesome chronic paronychia. The anatomy and pathophysiology of this condition are discussed briefly.
Nineteen of fifty adult female patients with chronic paronychia and five of fifty adult female control dermatological patients suffered from psoriasis.
Prevotella bivia is mainly associated with endometritis. The case of a patient with paronychia in a thumb due to P. bivia resulting in osteitis and amputation is reported. The species was not acknowledged in the first bacterial culture 2 weeks before surgery.
Paronychial infection is a common condition seen in the accident and emergency department. Treatment is by antibiotics or incision and drainage under local anaesthetic. Complications are rare but may occur if treatment is delayed or inadequate. A case is described of symmetrical necrotising chest wall infection, of unusual anatomical distribution, that occurred following a paronychia and required surgical debridement and skin grafting.
BACKGROUND: The introduction of HIV-1 protease inhibitors into the treatment of patients infected with HIV-1 has had a major influence on clinical practice. However, the use of protease inhibitors is frequently associated with the development of resistance and several side effects and interactions with other drugs have been reported. OBSERVATIONS: We present the first pediatric patient with paronychia with pyogenic granuloma associated with the administration of the protease inhibitor indinavir. Clinical findings are discussed in view of a possible interference of indinavir with endogenous retinoid metabolism. CONCLUSION: Considerable evidence advocates the mediation of indinavir side effects by impaired oxidative metabolism of retinoic acid through the inhibition of cytochromes P450 3A by indinavir rather than by impaired formation of 9-cis-retinoic acid.
We hypothesized that onset of sensory block is delayed in infected versus healthy tissues within the same nerve distribution after axillary brachial plexus block (ABPB) and that clonidine added to mepivacaine would enhance anesthesia and postoperative analgesia. Forty-one outpatients undergoing thumb/index paronychia surgery under ABPB were randomly assigned to receive in a double-blind fashion 400 mg mepivacaine plus either 100 microg clonidine (clonidine group, n = 21) or 2 mL saline (placebo group, n = 20). Onset of sensory block in the infected area was delayed compared with healthy areas of the same nerve distribution (24.7 +/- 5.5 min versus 21.3 +/- 7.2; P = 0.02 for median and 21.6 +/- 7.8 min; P = 0.04 for radial) within the placebo group. In the clonidine group, when compared to placebo i) onset of sensory block in both the median and radial nerve territories was accelerated (11.1 +/- 5.6 and 10.5 +/- 5.2 versus 21.3 +/- 7.2 and 21.6 +/- 7.8 min, respectively; P < 0.001), ii) onset of sensory block in the region of infection was accelerated (9.1 +/- 1.9 versus 24.7 +/- 5.5 min; P < 0.001), iii) duration of anesthesia (275 +/- 75 versus 163 +/- 57; P = 0.04) and time to first analgesic requirement (279 +/- 87 versus 197 +/- 84 min; P = 0.002) were prolonged with decreased visual analog scale scores at this time (30 +/- 18 versus 70 +/- 24; P < 0.001), and iv) verbal numeric rating scores were decreased at 24 h (1.7 +/- 2.2 versus 4.1 +/- 3.0; P = 0.002) and 48 h (0.1 +/- 0.5 versus 1.5 +/- 2.4; P = 0.01) postoperatively. Our findings suggest that in the setting of distal infected tissue surgery under ABPB infected tissues are resistant to anesthesia compared with healthy areas within the same nerve distribution and clonidine added to mepivacaine enhances both anesthesia and postoperative analgesia.
The aerobic bacterial flora of 63 cases of onicolysis 78 of paronychis and 5 of onicomadesis produced by yeast-like fungus were studied. Bacterial isolation was carried out in nutrient agar with a concentration of 10 mug/ml of nystatin. These microorganisms were identified following the Otto Bier and Bailey & Scott's techniques (3, 1). Bacterial contamination was very frequent. One species or more were isolated from 93,6% of onicolysis and 97% of paronychis. The onicolysis presented the following flora: "Staphylococcus aureus" in 22 cases, "Staphylococcus epidermidis" in 21, Gram positive sporulated bacilli in 17, "Enterobacteriaceae" in 13, and "Pseudomona aeruginosa" in 6. The paronychial lesions showed the following flora: "Staphylococcus aureus" in 21 cases, "Staphylococcus epidermidis" in 26, Gram positive sporulated bacilli in 17, "Enterobacteriaceae" in 17 and "Pseudomona aeruginosa" in 3. It is important to emphasize that "Pseudomona aeruginosa" was isolated in a few cases of both types of candidal onixis, contrary to usual reports (2, 4, 9). No significant difference between the aerobic bacterial flora of the onicolysis and paronychia was found, that would give an explanation of the existence of these two clinical forms of candidal nails infection.
Chemotherapeutic agents may induce a wide variety of adverse mucocutaneous effects, including nail changes. We present a case of atypical onycholysis, associated with subungual abscess formation, paronychia and pyogenic granuloma resulting from the use of mitozantrone, an antineoplastic cytotoxic agent, in the treatment of metastatic prostate cancer.
Infections of the distal finger have a varied presentation, course, and treatment. As in other hand infections, initial treatment should always include elevation of the extremity and the avoidance of snug clothing or constricting jewelry. Immunosuppressive states and systemic diseases such as diabetes must be considered, for they will alter the action of the causative organisms as well as the intensity of treatment that a patient will require. Appropriate, specific antibiotic treatment can be part of the initial treatment of acute felons and paronychias, but it should never replace adequate incision and drainage. Finally, "minor" finger infections are only minor when diagnosed and treated properly. If mistreated, their consequences can have long-term implications for both the individual and for society. It is important to understand the natural history, bacteriology, and anatomy of the distal finger if we are to return patients to their jobs with expedience and minimal long-term sequelae.
This paper reports on the association of two uncommon side effects of isotretinoin therapy for cystic acne: paronychia and excess granulation tissue in the nail sulci. An explanation for these side effects is suggested, but the exact pathogenesis remains obscure.
Paronychia granulomatosa is a complication incident to unguis incarnatus; surgery for this complaint was performed on 26 patients with 52 granulomas. The operation was first described by Bartlett in 1937. The postoperative hospitalization was 3 days and the patients returned a week later to have the sutures removed. After the operation, ten remaining granulomas were observed of which 6 were cured by operation and 2 conservatively, leaving 2 under continuing conservative treatment (5 months and 1 month, respectively).
Subsequent to an autopsy of a tuberculotic cadaver, a pathology resident presented with a painless paronychia and axillary adenopathy after surgical incision and broad-spectrum antibiotics had failed to improve his condition. Demonstration by culture of Mycobacterium tuberculosis var hominis, positive smears, and findings of acid-fast organisms in a skin biopsy specimen proved the diagnosis of tuberculosis. Conversion of a previously negative skin test permitted the diagnosis of primary inoculation tuberculosis of the skin. The disease responded well to treatment with isoniazid, rifampin, and pyridoxine hydrochloride.
An interesting case of chronic paronychia of the big toe for the last 6 years resulting in granulomatous reaction and hypertrophy of nail plate and bed is being reported. An increased rate of longitudinal growth of nails may occur in association with infection around the nail, in bullous, ichthyosiform erythroderma and in psoriasis as already reported, but a unique feature in this patient was the increase in size of the nail plate in all directions, along with simultaneous increase in the surface area of the nail bed.
Herpes simplex infection of the hand is often falsely diagnosed as a pyogenic paronychia or felon and treated as such, because the clinical picture is not known and pathogen isolation is difficult. However, the surgical treatment of herpes digitalis is contraindicated, since it promotes the development of superinfections and triggers recurrence. The pathogen can be isolated in cell cultures prepared from the vesicle contents or a smear from the vesicle base. Serological antibody testing is unreliable. Topical application of Acyclovir cream (Zovirax) is the treatment of choice.
Experience in the treatment of 41 patients with osteoarticular paronychia and 14 patients with osteoarthritis of the metacarpophalangeal articulations is discussed. The treatment consists in arthrotomy, careful curettage of the tissues of the involved articulation and its through drainage, application of a primary suture to the wound, and application of a distraction apparatus. Graded distraction of the articulation ensures its decompression, which prevents progression of bone destruction and creates favorable conditions for regeneration of the articular ends, and prevents the formation of coarse cicatricial adhesions and ankylosis. All these measures make it possible to restore the function of the affected articulation.
Paronychias and felons are the most commonly encountered hand infections. Successful management of an uncomplicated infection involves an accurate diagnosis and prompt initiation of treatment, consisting of the judicious use of an appropriate incision, wound drainage, local wound care, antistaphylococcal antibiotics, and early rehabilitation. Complicated infections occur in immunosuppressed patients or those whose infection has been neglected or mistreated. Treatment of such infections is individualized.
An outbreak of methicillin-susceptible Staphylococcus aureus pyoderma occurred in the nursery of a tertiary-care referral center. All strains retrieved from the outbreak, including one from a nurse's infected finger, were typed by arbitrarily primed polymerase chain reaction and automated ribotyping. The results indicated that the spread of the outbreak was probably facilitated by contamination of the nurse with paronychia.
A case of fixed-drug eruption due to cefalexine presented with acute paronychia. Twenty days after a further challenge with a single dose of the drug, a biopsy of the affected skin showed intense expression for ICAM-1.