Hand Case 15 ED Management

The ED management of paronychia depends on whether or not clinically there is an abscess present.

If there is no abscess: instruct the patient to soak the affected finger in warm water, with or without antibacterial soap, for 10-15 minutes, 4-6 times daily. After each soak, they should apply a triple-antibiotic ointment or mupirocin directly to the affected area.

If there is an abscess present: it should be drained in the ED. This can be done by using either an 18-gauge needle or an 11-blade scalpel to lift up and separate from the nail (rather than making a frank incision), as well as drain the swollen cuticle. Most patients tolerate the brief procedure well with no anesthesia, but a digital nerve block can also be offered. Warm soaks have also been shown to increase comfort and facilitate ongoing drainage after I&D.

Topical or oral antibiotics are usually unnecessary after successful I&D. For immunosuppressed patients, poorly controlled diabetics, severe cases, or patients returning for worsening symptoms, oral antibiotics are indicated. Dicloxacillin or cephalexin have good antistaphylococcal coverage and can be prescribed for a five-day course.