Acute paronychia
Usually staph. aureus
- Ask advice
- Pus confined to nail fold; I & D under ring block.
- Pus under nail; remove wedge of nail or whole nail under ring block.
- Antibiotics are rarely needed.
Chronic paronychia
Usually candida infection.
- Treat with antifungal cream rubbed into nail fold tds and every time patient gets hands wet.
Pulp space abscess
Usually staph. aureus
- If severe, X-ray to exclude osteomyelitis
- I & D over most tender spot, (mark before injecting L.A.)
- Antibiotics rarely needed
Severe infections eg tendon sheath infections, palmar space infections, severe cellulitis
- Refer to Hand Surgery service for iv antibiotics +/- exploration