A Simple Guide to Paronychia

A Simple Guide to Paronychia
-----------------------------------

What are Paronychia?
--------------------------

Paronychia is acute or chronic infection of the tissue surrounding the nails of fingers or feet.

What are the Causes of Paronychia?
---------------------------------------------

There are two main causes of Acute Paronychia:
1.Bacteria-pseudomonas, Proteus,staphylococus

2.Fungal- candida

Chronic Paronychia:
1.Fungal- candida

2.Bacterial-pseudomonas

Micro-organisms usually enter through injured or damaged tissues from a ingrowing nail or sharp nail.

Tissues around the base of the cuticles becomes infected and inflammed, usually on one side of the nail.

Pus may form and oozes from the infected tissues.

What are the Symptoms of Paronychia?
----------------------------------------------

1.Acute paronychia:
----------------------

1.swollen

2.painful

3.red nail fold

4.may dicharge pus

2.Chronic paronychia
-----------------------

1.recurrent

2.painful

3.swollen tissues at base of nail

4.pus may be present

5.nail plate may rigid, distorted or invaded by micro-organism

What are the investigations for Paronychia?
----------------------------------------------

Swab for culture and sensitvity to antibiotics

Exclude Diabetes

What is the Treatment of Paronychia?
----------------------------------------------

Acute Paronychia:
-----------------------

1.Systemic antibiotics

2.Incision and drainage of pus

3.Surgical excision of part of the cuticle causing tissue damage(Ingrowing toenails) and the removal of infected lateral nail folds

Chronic Paronychia:
---------------------

1.Keep hands dry and use protective gloves

2.Apply anti fungal lotions and creams such as clotrimazole, nystatin

3.Systemic anti fungals such as griseofulvin or ketoconazole

4.Treat secondary bacterial infections with antibiotics

What are the Prevention measures in Paronychia?
---------------------------------------------------------

1.Avoid pressure on the lateral folds of the nails

2.Footwear should not be too tight

3.Avoid biting of nails

4.Avoid constant contact with water and soaking in water

5.Cutting of nails should not be too deep

6.Good personal hygience

A Simple Guide to Candidiasis

A Simple Guide to Candidiasis
------------------------------------

What is Candidiasis ?
-------------------------

Candidiasis is caused usually by the fungus Candida albicans.
Other Candida species or yeasts are also responsible.

What are the causes of Candidiasis ?
-------------------------------------------

1. Broad spectrum Antibiotic therapy kills off normal bacterial flora, resulting in invasion of fungi or yeasts
2. Diabetes mellitus - the high sugar content in the blood and vagina lining are conducive to fungal or yeast infection
3. Steroid or immunosuppressive drugs suppress the immune response to bacterial and fungal infection.

What is the symptoms of Candidiasis ?
----------------------------------------------

30% of patients do not have any symptoms.
The rest have symptoms like:
1. pruritus,

2.vaginal soreness,

3.dyspareunia,

4.external dysuria, and

5.abnormal white transparent vaginal discharge with heavy odour.

About 75% of women will have at least one episode of Candidiasis, and 45% may have two or more episodes.

How do you diagnose Candidiasis ?
------------------------------------------

A diagnosis of Candida vaginitis is made clinically by the presence of:
1.external dysuria

2.vulvar pruritis, pain, swelling, and redness.

3. vulvar edema, fissures, excoriations,

4.thick curdy vaginal discharge.

The diagnosis is confirmed by
1) a Gram stain of vaginal discharge showing the presence of yeasts
2) a vaginal swab for culture shows the presence of a yeast species.

What is the treatment of Candidiasis ?
---------------------------------------------

Short-course intravaginal antifungal pessaries effectively treat uncomplicated Candidiasis .
The topically applied imidazole drugs are more effective than nystatin.
90% of patients are usually cured.

Oral Agent such as Fluconazole 150 mg may be given in one tablet in single dose.

Patients should be instructed to return for follow-up visits only if symptoms persist.

Candidiasis is not usually acquired through sexual intercourse.

A minority of male sex partners might have balanitis, which is characterized by itchy red areas on the glans of the penis.
These men benefit from treatment with topical antifungal agents to relieve symptoms.

Topical agents usually do cause any systemic side effects although in some people local burning or irritation might occur.
Oral agents sometimes cause nausea, abdominal pain, and headache.
Some abnormal elevations of liver enzymes may occur with treatment with the oral azoles.

What are the complications of Candidiasis?
---------------------------------------------------

1.Recurring Candidiasis:A small percentage of women (<5%)>.
The majority of women with recurring Candidiasis have no apparent predisposing or underlying conditions.
Vaginal cultures should be obtained from these patients to confirm the clinical diagnosis and to identify unusual species, including nonalbicans species, particularly Candida glabrata
Conventional antimycotic therapies are not as effective against these species as against C. albicans.

A longer duration of initial therapy is necessary to attempt mycologic remission before initiating a maintenance antifungal regimen:

Oral fluconazole (i.e., 100-mg, 150-mg, or 200-mg dose) weekly for 6 months
topical clotrimazole 200 mg twice a week,
clotrimazole (500-mg dose vaginal pessaries once weekly)

2.Women with underlying debilitating medical conditions (e.g., uncontrolled diabetes or on corticosteroid treatment) do not respond as well to short-term therapies.
The underlying diseases should be treated and more prolonged (i.e., 7–14 days) conventional antimycotic treatment is necessary.

3.During pregnancy, Candidiasis is quite common.
Only topical azole therapies, applied for 7 days, are recommended for use .
Oral treatment is contraindicated because of risks of deformity in the foetus.