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ParonychiaCase report:In a 27-year-old construction worker there for three days a reddened and painful swelling in the posterior nail fold at the right forefinger. The patient claims to have been injured a few days before the onset of symptoms at work, but the small superficial wound was primarily a healing tendency. For two days the patient reported throbbing pains that bother him especially at night and are aggravated when the arm hangs. Fever does not exist. Comment:The clinical findings of an inflammatory swelling of the nail fold, which has developed after a superficial injury to the skin, suggests a diagnosis of paronychia. The pathogens are in most cases to Staphylococcus aureus; Streptococcal species come less into consideration. After superficial skin lesions, it is not rare for a superinfection of small wounds by staphylococci, which can penetrate into the lower layers of the skin deszendierend. In normal spontaneous course it comes after a few days to perforation in the area of nail fold, causing the abscess located in the subcutaneous tissue can be draining. Blande forms of paronychia can therefore be treated primarily anti-inflammatory. When findings are pronounced, however, the spread of infection in the direction of the fingertip and the Fingerendgelenkes is conceivable. Therapy:
For little extensive findings Just send an anti-inflammatory as well as a local therapy that promotes perforation inclination. In broader findings surgical intervention must be followed, which is usually under regional anesthesia and tourniquet the stove from the nail fold from is excised. Occasionally, a complete or partial removal of the nail is needed to ensure adequate drainage is provided. Antibiotics are not necessary in these superficial infections usually. If it is a location beneath the nail paronychia (Paronychia subungual), so must be carried out in any case, a partial removal of the nail through the translucent infection with additional nail bed removal.
Dosages:
Dicloxacillin Flucloxacillin or: 2 to 3 g daily oral distributed in the adult and 50 mg / kg body weight on three doses in children.
Unsuitable in this case:Not suitable for the therapy appear substances with a broad spectrum of activity in Gram-negative area and a pronounced weakness staphylococci. Also tetracyclines or cotrimoxazole (EUSAPRIM) are not taken into account in the indications for antibiotic treatment of paronychia. |
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