Treatment of chronic paronychia?

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Hi Everyone,

I am currently treating a 29 y.o lady which presented with chronic paronychia of proximal nail fold of her Right Hallux for 3/12 after damaging her cuticle with a "cuticle pusher".

Significant history:
* +ve swab test to staph (by GP 2 months ago)
* history of use of Keflex, flucloxacillin, clindamycin from GP and specialist with minimal improvement.

On observation:
Excessive redness and swelling of the Right hallux proximal nail fold
Tender to touch
Pain with direct pressure on proximal nail fold
Yellow pus appears on the lunula of the nail plate
Cuticle is able to be lifted off the nail plate (via blacks file)

Initial Tx plan:
1. control bacterial loading - betadine 2x daily for 1 week, salt water bath daily
2. control possible fungal infections - hydrozole cream 3x daily.
3. x-ray to rule out any osteomyelitis
3. open footwear advised

On 1 week review, throbbing, burning, sharp pain especially at night, able to wake patient up; occurring for 1+ weeks, requiring self-medication of nurofen (NSAID). All creams, footsoaks were advised to be stopped

Management today (aim to clear pus, reduce bacterial loading and swelling):
1. Ring block of Right hallux, cleared out pus and tissue in area between proximal nail fold and nail plate (swelling was observed on dorsum of proximal nail fold but no pus).
2. bactigras packing of junction between proximal nail fold and nail plate, and surrounding nail plate.
3. dressed and advised to keep dry from showers, review in 3 days
4. Oral antibiotics from GP
5. Using nurofen as necessary to control pain

would anyone be able to offer feedback and any further advice on management of this debilitating condition?

It's very lengthy but thank you very much for your time!

 

Have HbA1c tested to exclude underlying diabetes. Good luck.

 

got any pictures?

 

Hi,

Just to enquire. What dosage were the antibiotics & also length of course prescribed. Have you considered MRSA? Have been reading that if MRSA then IV antibiotics may be required. Interested in the outcomes.

Patients infected with MRSA

Kindest regards,

Mandy.

 

Thanks for the reply Mandy. The patient was not aware of the dosage, but a total of 4 courses of clindamycin were taken. There was a swab taken at the hospital (unfortunately, no report) and the patient was told she had a "staph" infection.

 

No pictures unfortunately