Skin and soft tissue infections

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Paronychia

Case report:

In a 27-year-old construction worker there for three days a reddened and painful swelling in the posterior nail fold at the right forefinger. The patient claims to have been injured a few days before the onset of symptoms at work, but the small superficial wound was primarily a healing tendency. For two days the patient reported throbbing pains that bother him especially at night and are aggravated when the arm hangs. Fever does not exist.

Comment:

The clinical findings of an inflammatory swelling of the nail fold, which has developed after a superficial injury to the skin, suggests a diagnosis of paronychia. The pathogens are in most cases to Staphylococcus aureus; Streptococcal species come less into consideration. After superficial skin lesions, it is not rare for a superinfection of small wounds by staphylococci, which can penetrate into the lower layers of the skin deszendierend. In normal spontaneous course it comes after a few days to perforation in the area of nail fold, causing the abscess located in the subcutaneous tissue can be draining. Blande forms of paronychia can therefore be treated primarily anti-inflammatory. When findings are pronounced, however, the spread of infection in the direction of the fingertip and the Fingerendgelenkes is conceivable.

Therapy:

For little extensive findings Just send an anti-inflammatory as well as a local therapy that promotes perforation inclination. In broader findings surgical intervention must be followed, which is usually under regional anesthesia and tourniquet the stove from the nail fold from is excised. Occasionally, a complete or partial removal of the nail is needed to ensure adequate drainage is provided. Antibiotics are not necessary in these superficial infections usually. If it is a location beneath the nail paronychia (Paronychia subungual), so must be carried out in any case, a partial removal of the nail through the translucent infection with additional nail bed removal.
If taking a leisurely finding which may be accompanied by the development of a lymphadenitis or even a bacteraemia, antibiotic therapy may be necessary, then recommend isoxazolyl-penicillins example Dicloxacillin (Infecto STAPH) or flucloxacillin (STAPHYLEX). Also combination preparations of a beta-lactam antibiotic and a beta-lactamase inhibitor (UNACID) or clindamycin (SOBELIN) are suitable.
Complications of inadequate drainage are infections of the deep soft tissues of the finger with the tendons and blood vessels of appropriate participation. In this case, surgical interventions are needed. In addition, should take place at broader findings and surgical resections an antibiotic with the preparations above. In rare cases, osseous infection can develop from the soft tissue inflammation of the fingers; here the treatment guidelines apply as for osteomyelitis.

Dosages:

Dicloxacillin Flucloxacillin or: 2 to 3 g daily oral distributed in the adult and 50 mg / kg body weight on three doses in children.
Clindamycin 300 mg orally three times, amoxicillin plus clavulanic acid (Augmentin) three 625-1250 mg orally or 100-150 mg / kg in children. Ampicillin plus Sulbactam (UNACID) two to three times daily orally 750-1500 mg and 50-100 mg / kg in children.

Unsuitable in this case:

Not suitable for the therapy appear substances with a broad spectrum of activity in Gram-negative area and a pronounced weakness staphylococci. Also tetracyclines or cotrimoxazole (EUSAPRIM) are not taken into account in the indications for antibiotic treatment of paronychia.

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