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Dear all,

I have a friend who has had symptoms which have appeared as Paronychia - please see attached photo I have uploaded. This has persisted for some 6-8 weeks with minimal improvement. He has had three courses of antibiotics including dicloxacillin. The antibiotics seem to afford some improvement however this deteriorates when ceased. A light yellow discharge occasionally weeps from the eponychium area, with occasional pus. The nail itself has not grown at all since these problems started.
He has tried saline soaks with Epsom salts religiously, topical anti fungal tincture which the GP recommended, magnoplasm, the aforementioned antibiotics - but still minimal improvement. The nail is not ingrown, but there is substantial fluid retention and swelling in the nail matrix area. Does anyone have any suggestions what this may be? He is becoming very concerned that it is not dissipating in an otherwise healthy 32yo male, who is not diabetic. He denies any traumatic injury or tight fitting shoes. Many thanks.

 

In situations like this - always this carcinoma - get it biopsied - yesterday

 

I agree - biopsy

 

To give it a definition is simple enough. It's onychomadesis. However, this only occurs when a problem has happened to the normal matrical growth; further history might help. However, I agree. If in doubt, biopsy without delay.

Bill Liggins

 

Agree with all the above and Bill is spot on; a labelling, or descriptive term, of clinical appearance is easy, but does not address the fundamental issue of cause. All lesions which are unresponsive to treatment and worsening require immediate referral for biopsy.

 

I agree to culture and biopsy.
I suspect this will turn out to be just an infection with granulation tissue that will resolve once the nail is removed.

good luck

Steve

 

Did imaging show anything? Possible with such a cocktail of topical treatments that the irritant effect is keeping the hypergranulation tissue going. But certainly not to be messed with and agree with other posters.
Ros