Onychia/Paronychia

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Onychia/Paronychia

Onychia – inflammation of the nailbed and matrix
Paronychia – inflammation of the proximal and lateral nail folds

Most due to Staphylococcus aureus and Streptococcus pyogenes – but up to a third have been reported to be anaerobic organisms.

Clinical features:
Acute - rapid swelling with inflammation and tenderness – may have purulent discharge  may lead to nail plate damage
Chronic – low-grade redness and swelling. Loss of eponychium common  gap between proximal nail fold and nail plate may get infected.

Treatment:
Usually respond well to incision and drainage. Offending piece (usually a spike) of nail must be removed.
May need antibiotics. May need to rule out osteomyelitis.
Not uncommon for patients to be placed on antibiotic by family doctor, with no attention paid to removal of offending piece of nail.

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