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• Re: Simple technique for paronychia management: aspiration by wide bore needle
  Dr. Rajesh Chauhan
  Published on: 29 April 2016
• Treatment of acute paronychia
  Alan M Leaman
  Published on: 29 April 2016
• Paronychia and advanced manicure.
  Cilla M Reid
  Published on: 29 April 2016
• Simple technique for paronychia management: aspiration by wide bore needle
  Dr. Rajesh Chauhan
  Published on: 29 April 2016
• Treatment for acute paronychia: Author's response
  Richard Body
  Published on: 29 April 2016

• Published on: 29 April 2016

  Re: Simple technique for paronychia management: aspiration by wide bore needle

  • Dr. Rajesh Chauhan, Consultant, Family Medicine & Communicable Diseases
  • Other Contributors:
    • Dr. Akhilesh Kumar Singh, MD; Dr. Parul Chauhan, MBBS, MISCD.

  Dear Editor,

  The technique used by us is quite useful for the superficial collection of pus at any other site as well. This requires simple aspiration. This aspiration technique can be used for hematoma collection also. The simplicity of aspirating rather than incising is readily acceptable to patients and can be easily performed as an OPD procedure.

  With regards.

  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Treatment of acute paronychia

  • Alan M Leaman, Consultant in Emergency Medicine

  Dear Editor,

  I am writing to express concern about the often nihilistic conclusions of many of the Best Evidence Reports appearing in the Journal. A case in point is the recent report on acute paronychia.[1]

  Acute bacterial paronychia is a painful condition which can progress to osteomyelitis. It's treatment, and indeed that of most bacterial abscesses, is drainage. This provides immediate relief of pain,...

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  Dear Editor,

  I am writing to express concern about the often nihilistic conclusions of many of the Best Evidence Reports appearing in the Journal. A case in point is the recent report on acute paronychia.[1]

  Acute bacterial paronychia is a painful condition which can progress to osteomyelitis. It's treatment, and indeed that of most bacterial abscesses, is drainage. This provides immediate relief of pain, prevents further complications, and avoids the unnecessary use of antibiotics. Given that these effects are obvious, and given the increasing problems with antibiotic resistance, it is wrong to conclude, as the authors have done, that acute paronychia may as well be treated with antibiotics as by drainage.

  AM Leaman

  Reference:

  1. Shaw J, Body R. Incision and drainage preferable to oral antibiotics in acute paronychial nail infection? Emerg Med J 2005; 22: 813-814.

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  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Paronychia and advanced manicure.

  • Cilla M Reid, A&E consultant

  Dear Editor

  When treating paronychia there is rarely any need for incision or aspiration. The infection usually enter via small lesions in the lateral nail fold. It can be drained in the same way. First the finger tip is soaked for approximatelky 10 minutes in saline. Then, under local anaestheic if necessary, the cuticle is pushed back along the lateral and proximal area of the nail. This opens up the potential s...

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  Dear Editor

  When treating paronychia there is rarely any need for incision or aspiration. The infection usually enter via small lesions in the lateral nail fold. It can be drained in the same way. First the finger tip is soaked for approximatelky 10 minutes in saline. Then, under local anaestheic if necessary, the cuticle is pushed back along the lateral and proximal area of the nail. This opens up the potential space through which the pus drains.

  Since learning this technique 10 years ago I have never had to use any sharp instruments on a paronychia.

  This technique has the advantage over incision and drainage in that it does not leave the patient with a new iatrogenic wound to heal.

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  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Simple technique for paronychia management: aspiration by wide bore needle

  • Dr. Rajesh Chauhan, Consultant, Family Medicine & Communicable Diseases.
  • Other Contributors:
    • Dr. Akhilesh Kumar Singh, MD; Dr. Parul Chauhan (Kushwah), MBBS, MISCD.

  Dear Editor,

  Having read the article by Jonathan Shaw[1], we would like to share a simple technique that we have using for managing acute paronychia with success, which may be equally beneficial to anyone dealing with this condition. Rather than using a scalpel, we have preferred using a wide bore needle (gauge 18 or 20) for aspirating pus, if it has pointed. This technique has also been favored by our patients o...

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  Dear Editor,

  Having read the article by Jonathan Shaw[1], we would like to share a simple technique that we have using for managing acute paronychia with success, which may be equally beneficial to anyone dealing with this condition. Rather than using a scalpel, we have preferred using a wide bore needle (gauge 18 or 20) for aspirating pus, if it has pointed. This technique has also been favored by our patients over the conventional incision and drainage.

  Antibiotics and topical applications usually suffice if the pus has not pointed. However once the pus is pointing, it requires a ‘release’. This can easily be provided by simple aspiration with a syringe capped with a wide bore needle (under asepsis), either with or without local anaesthetic support. For the grown ups and adults, spray of ethyl chloride is quite useful and suitable for this purpose. For children who are by and large apprehensive, premedication with a tranquillizer followed by ethyl chloride spray in the usual fashion, does the trick as the procedure is very short indeed. Needle tip is carefully passed until the skin punctures and pus is aspirated out. If patient was already on antibiotics, the same or another one is followed for next few days, whereas for the fresh cases a loading dose of antibiotic is prescribed and followed for just two to three days.

  This technique allays the apprehension to a great extent as also the after pain, and also cuts down the cost of management. It is a simpler procedure for the management of acute paronychia and does not require any expertise or training.

  With regards.

  References:

  1. Shaw J. Incision and drainage preferable to oral antibiotics in acute paronychial nail infection? Emergency Medicine Journal 2005; 22: 813 -814.

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  Conflict of Interest:
  None declared.

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• Published on: 29 April 2016

  Treatment for acute paronychia: Author's response

  • Richard Body, Clinical Research Fellow

  Dear Editor,

  I read with interest the comments regarding the Best Evidence Topic Report (BET) entitled “Incision and drainage preferable to oral antibiotics in acute paronychial nail infection?” and would be delighted to provide justification for the conclusion[1]. Acute paronychia is one of the most common infections of the hand. Far from being a simple digital abscess, acute paronychia represents a dynamic...

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  Dear Editor,

  I read with interest the comments regarding the Best Evidence Topic Report (BET) entitled “Incision and drainage preferable to oral antibiotics in acute paronychial nail infection?” and would be delighted to provide justification for the conclusion[1]. Acute paronychia is one of the most common infections of the hand. Far from being a simple digital abscess, acute paronychia represents a dynamic and evolving condition. The patient initially complains of pain and tenderness in the paronychial fold, which appears erythematous and inflamed. If the infection persists, a collection of pus may develop, forming an abscess around the paronychium. Left untreated, this may spread under the nail sulcus to the opposite side, creating a “run-around abscess”[2-4].

  In clinical practice within the Emergency Department, patients present at different stages along this continuum of infection. Although it is widely held that acute paronychia mandates surgical management, many paronychiae are treated conservatively by general practitioners, using oral antibiotics. Indeed, this approach has been advocated for early infections in the literature, as have warm-water soaks[2].

  BETs are designed to summarise the best available evidence to answer a specific and well-defined clinical problem. The BET in question describes the clinical scenario of a patient who has neither obvious fluctuance and abscess formation nor trivial erythema. In the experience of the two authors, this presentation is not uncommon and presents a dilemma for the Emergency physician. If surgical management confers no benefit over the conservative approach, avoidance of an unpleasant and unnecessary surgical procedure may be beneficial for the patient.

  Following independent exhaustive literature searches and review at the Manchester Royal Infirmary Emergency Medicine Journal Club, we were unable to identify any relevant comparative trials to answer the three-part question. As such, our conclusion that there is no evidence that a surgical approach is either better or worse than conservative treatment in this situation is justified.

  In the absence of relevant evidence in the literature we do not, however, state that either approach is of equal benefit. We clearly state that if pus is present in acute paronychial nail infection, our current practice is to incise and drain the abscess. Further, we highlight an interesting area for potential future research.

  References

  1. Shaw J, Body R. Incision and drainage preferable to oral antibiotics in acute paronychial nail infection? Emergency Medicine Journal 2005; 22: 813-814.

  2. Rockwell PG. Acute and chronic paronychia. American Family Physician 2001; 63: 1113-1116.

  3. Jebson PJL. Infections of the fingertip: Paronychias and felons. Hand Clinics 1998; 14: 547-555.

  4. Canales FL, Newmeyer WL 3rd, Kilgore ES. The treatment of felons and paronychias. Hand Clinics 1989; 5: 515-523.

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  Conflict of Interest:
  None declared.

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