Paronychia: The Daily PANCE Blueprint

Home Paronychia: The Daily PANCE Blueprint

Paronychia: The Daily PANCE Blueprint

A 32-year-old female presents with pain around her nail fold on the index finger of her right hand. She is afebrile. On physical exam, you appreciate erythema and swelling of the proximal nail fold. The area is not fluctuant. Which of the following is the best treatment option?

A. Topical antibiotics and warm water soaks
B. Intravenous antibiotics
C. Oral antibiotics and incision and drainage
D. Surgical consult for removal
E. None of the above

Answer and topic summary

The answer is A. Topical antibiotics and warm water soaks

The patient has an acute paronychia, which is a very common condition and essentially is just inflammation of the nail folds. The most common bacterial causes are Staph aureus and Strep pyogenes. Risk factors include manicures, nail-biting, and picking at nails. Clinical features include sudden onset of painful erythema and swelling. Sometimes an abscess will be present. In this patient’s case, there was no fluctuance and so topical antibiotic and warm water soaks would be appropriate.

If the patient had an abscess, oral antibiotics and incision/drainage (with number 11 surgical blade) would be reasonable.

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Disorders of the Hair and Nails ⇒ Paronychia

Also covered as part of the Family Medicine EOR topic list