Clinical and cytologic features of antibiotic-resistant acute paronychia

• Published in: Journal of the American Academy of Dermatology Vol. 70; no. 1; pp. 120 - 126.e1
• Main Authors: Durdu, Murat, MD, Ruocco, Vincenzo, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2014
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antifungal Agents - therapeutic use; Antiviral Agents - therapeutic use; Candidiasis, Cutaneous - complications; Candidiasis, Cutaneous - diagnosis; Candidiasis, Cutaneous - drug therapy; Child; Child, Preschool; Dermatology; diagnosis; Drug Resistance, Microbial; erythema multiforme; Fingersucking - adverse effects; fungus; Herpes Labialis - complications; Herpes Labialis - diagnosis; Herpes Labialis - drug therapy; herpes virus; Humans; Infant; infectious diseases; Middle Aged; Nail Biting - adverse effects; orf virus; Paronychia - drug therapy; Paronychia - etiology; Paronychia - pathology; Pemphigus - complications; pemphigus vulgaris; Retrospective Studies; Staphylococcal Skin Infections - complications; Staphylococcal Skin Infections - diagnosis; Staphylococcal Skin Infections - drug therapy; Stomatitis, Herpetic - complications; Stomatitis, Herpetic - diagnosis; Stomatitis, Herpetic - drug therapy; Tzanck smear; Wounds and Injuries - complications; Young Adult; Tzanck smear; fungus; pemphigus vulgaris; infectious diseases; diagnosis; orf virus; erythema multiforme; herpes virus
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2013.09.042

Background Acute paronychia usually is treated as a bacterial infection, but antibiotic-resistant acute paronychia may be caused by other infectious and noninfectious problems. Objective We sought to describe the clinical, etiologic, cytologic, and therapeutic features of antibiotic-resistant acute paronychia. Methods A retrospective review of medical records and cytology was performed in 58 patients (age, 1 month-91 years; 36 children and adolescents [62%] and 22 adults [38%]) who had antibiotic-resistant acute paronychias. Results Causes of paronychia included bacteria (25 patients [43%]), viruses (21 patients [36%]), fungi (5 patients [9%]), drugs (3 patients [5%]), pemphigus vulgaris (3 patients [5%]), and trauma (1 patient [2%]). Diagnostic cytologic findings were noted in 54 patients (93%); no diagnostic cytologic findings were present with drug-induced (3 patients) or traumatic (1 patient) paronychia. The most common predisposing factors were the habits of finger- or thumb-sucking (14 patients [24%]) and nail-biting (11 patients [19%]). Complications included id reaction with erythema multiforme in 3 patients (5%). Limitations Limitations include retrospective study design from 1 treatment center. Conclusion Antibiotic-resistant acute paronychia may be infectious or noninfectious. Cytologic examination with Tzanck smear may be useful diagnostically and may prevent unnecessary use of antibiotics and surgical drainage.