Panaris: An Infection Of The Finger To Be Disinfected Without Delay.

The paronychia is a painful bacterial infection of a finger, usually near a fingernail. It must be treated without delay because it can be complicated by deep infections.

What is a paronychia?

A paronychia is a bacterial infection that can occur on the fingers of the hand (or toes), most often at the end of the finger and near a fingernail.

It is caused by a bacterium, staphylococcus aureus in 70% of cases (or an enterococcus, streptococcus, anaerobic germ) that penetrates under the skin during a small injury.

The paronychia (f fingers) begins 2 to 5 days later by an inflammatory phase with swelling and a painful and localized redness of the skin. At this stage, the pain subsides at night and, with appropriate local treatment , paronychia regresses and heals in a few days.

In the absence of care, the paronychia can “ripen”, that is to say that the pus collects and evolves towards an abscess with the formation of a pocket of pus under the skin, visible in the form of a hard and painful yellow ball. The pain becomes nagging , disturbing sleep, sometimes accompanied by fever and swelling of the armpit lymph nodes under the arm. This stage is irreversible spontaneously and the treatment is then necessarily surgical.

What are the causes of paronychia?

For a whitlow to form, Staphylococcus must find a way into the skin .

It is often a small wound , often minimal, or even unnoticed, for example during manicure care a little pushed, including removal of cuticles, when you eat a fingernail or tear a small skin in the corner the nail, or during a sting or the entry of a splinter under the skin

Some chronic diseases (diabetes, immunodeficiency) or certain treatments (corticosteroids, immunosuppressors) promote the development of infections.

What are the complications?

  • If proper care is not provided, the infection can spread deeper and reach the tendons, joint and bone.
  • When the infection has not been completely eradicated by treatment, paronychia can recur .

What can be done in case of paronychia?

  • Always check that your tetanus vaccination is up to date.
  • In the early inflammatory stage , the treatment is local . It consists of painful finger baths in an antiseptic fluid (Dakin solution, Hexomedine) three times a day .
  • Between the finger baths, the area is protected by a sterile compress after application of an antibiotic cream (Fucidine, Mupiderm ) for antistaphylococcal purposes .
  • The improvement must occur within 48 hours , and without improvement within this time, the attending physician must be consulted.
  • Any attempt at “self-treatment” with a needle or instrument to drain pus is strictly discouraged, regardless of the stage of evolution of the paronychia.
  • At the constituted abscess stage , the treatment is surgical and urgent . It consists of an incision by the surgeon and a cleaning of the lesion under local anesthesia. The bacterium responsible is removed and then identified in culture, which allows the adaptation of antibiotic treatment, which is not systematic.

In case of paronychia (fresh fingers), it is essential to avoid cooking or handling food because staphylococci present in the paronychia can then contaminate food and cause acute diarrhea in people who consume them. For the profession of mouth (cook, pastry chef), it is essential to stop his activity until healing.

When should I see a doctor?

It is necessary to consult the attending physician within 24-48 hours, if the tetanus vaccination is not up to date, if there is no improvement after 24 hours of local care (finger baths/ fresh fingers buy), if the pain becomes throbbing and pulsatile, possibly with fever, in case of abscess formed with pus and in case of diabetes or corticosteroid treatment.

The collected whitlow is a medico-surgical emergency.

How to prevent a paronychia?

  • To prevent the appearance of a paronychia, it is necessary to  limit the risk factors  : to avoid to eat the nails (“onychophagie”) and the small skins around (called “desires”), to avoid to push back the cuticles (the small zones covering the base of the nail) during manicure and wearing gloves for manual work.
  • You must take care of any wound with your finger or your hand  : wash and disinfect it several times a day, and apply a bandage.
  • In case of splinter or spine before penetrating under the skin, it is necessary to clean the skin before attempting to extract it, by removing the skin rather than pressing it, and by disinfecting with an antiseptic before using a needle or tweezers to extract it.

All of this preventive care is all the more important as there are  risk factors for complications of paronychia (diabetes, corticosteroid treatment, immunosuppression).