Hand Case 15 Diagnosis

Paronychia is a clinical diagnosis based on physical exam findings of periungal pain, tenderness, swelling, and erythema or purulent discoloration.  If it is a toe, examine closely for an ingrown nail that would need to also be treated.

If there is history of significant preceding trauma, or clinical suspicion for osteomyelitis or deep space infection, then additional imaging, such as x-rays of the finger, and consultation with a hand surgeon may be necessary.

Important “can’t miss” diagnoses include:

Felon – an infection of the pulp of the pad of the finger which requires a different drainage approach.

Herpetic whitlow - HSV infection causing vesicular rash along the distal finger and should not be drained! Whitlow is characterized by vesicles.