Paronychia is an infection of the skin around a fingernail or toenail.

Definition

Paronychia is an infection of the skin around a fingernail or toenail. The infected area can become swollen, red, and painful, and a pus-filled blister (abscess) may form. Most of the time, paronychia is not serious and can be treated at home. In rare cases, the infection can spread to the rest of the finger or toe and lead to a deeper infection that may require a doctor’s help. It’s unlikely that your child will get paronychia in a toe (unless he or she has an ingrown toenail). But fingernail paronychia is one of the most common hand infections.

Nail Structure and Function

The nail is a complex unit composed of five major modified cutaneous structures: the nail matrix, nail plate, nail bed, cuticle (eponychium), and nail folds. The cuticle is an outgrowth of the proximal fold and is situated between the skin of the digit and the nail plate, fusing these structures together. This configuration provides a waterproof seal from external irritants, allergens, and pathogens.

Types of Paronychia

There are primarily two types of paronychia which may develop around the finger or toenails. These are classified by the time duration that the skin infection lasts.

Acute Paronychia: The skin infection develops fast and lasts for a few days in acute paronychia. This kind of paronychia is seen following skin breaks during a manicure, or when infection sets into an ingrown toenail. It is usually bacterial in nature, often caused by straphylococcus aureus bacteria. However, germs from the cold sore virus like herpes simplex or yeast such as Candida may also cause the condition.

Chronic Paronychia: The infection develops slowly and may last for many weeks. In such cases, a mix of multiple pathogens causes the infection. A combination of yeast like candida, virus like herpes simplex, and bacteria like Staphylococcus aureus may be found. This condition is commonly found in people who have to work with their hands constantly being exposed to water, chemicals and detergents. It has a tendency to reoccur even after being treated and cured.

The third variety of paronychia is a subungual abscess, which occurs in the same location as a subungual hematoma and presents with pain and entrapped pus that is visible between the nail plate and the nail bed

Risk factors of Paronychia

Acute: direct or indirect trauma to cuticle or nail fold, manicured/sculptured nails, nail biting, thumb sucking, manipulating a hangnail

Chronic: frequent immersion of hands in water with excoriation of the lateral nail fold (e.g., chefs, bartenders, housekeepers, swimmers, dishwashers, nurses)

Predisposing conditions such as diabetes mellitus (DM) and immunosuppression

Medications such as EGFR inhibitors, systemic retinoids, chemotherapy and antiretroviral agents

Causes of Paronychia

The infection occurs when the skin around the nail becomes damaged, allowing germs to enter.

Bacteria or fungi can cause paronychia, and common culprits are Staphylococcus aureus and Streptococcus pyogenes bacteria.

Common causes of skin damage around the nail include:

Biting or chewing the nails

Clipping the nails too short

Manicures

Excessive exposure of the hands to moisture, including frequently sucking the finger

Ingrown nails

Paronychia Symptoms

If your child has paronychia, it’s usually easy to recognize. Look for:

  • An area of red, swollen skin around a nail that’s painful, warm, and tender to the touch
  • A pus-filled blister

A pus-filled blister

Bacterial paronychia:

  • Usually appears very suddenly

Fungal paronychia:

Can take longer to notice and causes less obvious symptoms

Can be a chronic condition (last for a long time)

Chronic paronychia can cause changes in the affected nail. It might turn a different color or look as though it is detached or abnormally shaped.

In rare cases, if the paronychia is especially severe and goes untreated, the infection can spread beyond the area of the nail.

Complications

Systemic implications and complications are rare but may include:

Abscess formation

Permanent deformation of the nail plate

Systemic fever/chills

Development of red streaks along the skin

Development of cellulitis or erysipelas

Joint pain

General ill feeling

Flu-like symptoms

Osteomyelitis

Flexor tenosynovitis

Diagnosis and test

Paronychia is a clinical diagnosis, often supported by laboratory evidence of infection.

Gram stain microscopy may reveal bacteria

Potassium hydroxide microscopy may reveal fungi

Bacterial culture

Viral swabs

Tzanck smears

Nail clippings for culture (mycology).

Treatment and medications

Paronychia is typically treated with antibiotics, although milder acute cases can often resolve on their own without treatment. The antibiotics most commonly used to treat paronychia are Bactrim (TMP/SMX) and a cephalosporin named Keflex (cephalexin).

If an anaerobic bacterium is suspected, Evoclin (clindamycin) or Augmentin (amoxicillin-clavulanate) may be given with Bactrim. Bactrim is especially effective against drug-resistant bacteria, including methicillin-resistant Staphylococcus aureus.

In severe cases, a physician can elevate the hardened bit of skin bordering the nail itself (eponychium) so that pus can be drained. Alternatively, the doctor can directly slice into the fluctuant portion of the infection; this procedure is no different from draining an abscess or boil.

Because paronychia are pretty superficial, anesthesia is unnecessary to drain most infections of pus. In fact, anesthetizing the area will likely result in added pain with little benefit.

Sometimes paronychia can extend under part of the nail. In these cases, either part or all the nail needs to be removed. A paronychia that is left untreated can sometimes surround the entire nail margin and result in a “floating” nail.

After a paronychia is drained of pus, there is usually no need for antibiotics. However, if the paronychia is accompanied by localized cellulitis or skin infection, then antibiotics are needed to treat the skin infection.

Surgical treatment of acute paronychia

Paronychia home care

Follow these guidelines when caring for yourself at home:

Clean and soak the toe or finger. Do this 2 times a day for the first 3 days. To do so:

Soak your foot or hand in a tub of warm water for 5 minutes. Or hold your toe or finger under a faucet of warm running water for 5 minutes.

Clean any crust away with soap and water using a cotton swab.

Put antibiotic ointment on the infected area.

Change the dressing daily or any time it gets dirty.

If you were given antibiotics, take them as directed until they are all gone.

If your infection is on a toe, wear comfortable shoes with a lot of toe room. You can also wear open-toed sandals while your toe heals.

You may use over-the-counter medicine (acetaminophen or ibuprofen) to help with pain, unless another medicine was prescribed. If you have chronic liver or kidney disease, talk with your healthcare provider before using these medicines. Also talk with your provider if you’ve had a stomach ulcer or gastrointestinal bleeding.

Prevention

To help reduce your chances of paronychia:

Keep your hands and feet clean and dry. Use a moisturizer after hand washing.

Wear rubber gloves if you often come in contact with water or chemicals.

Avoid biting or picking your nails.

Practice proper hygiene. Do not share bathroom supplies.

Avoid cutting, pulling, or tearing your cuticles.

Avoid artificial nails, vigorous manicures, or treatments that remove the cuticles.

ARSADIC president have charged Nigerians to wake up and resort to the use of traditional protection.

Nigerians should resort to the use of traditional protection, following the massacre in Owo, Ondo State.

At least 40 people have died since the brutal attack on St. Francis Catholic Church by gunmen. Those injured are receiving treatment.

Some suspects have been arrested, a development linked to incantations by traditionalists and supplications to the gods.

Reacting, Chief Ifagbenusola Atanda, President of Ancient Religion Societies of African Descendants International Council (ARSADIC) charged Nigerians to wake up.

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Anambra state government demolishes kidnappers hideout.

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FG lauded Ekiti state for reversing land degradation.

The Federal Government has lauded the performance of Ekiti State in the execution of the World Bank-assisted Nigeria Erosion and Watershed Management Project, in the areas of reversing land degradation and erosion control.

A statement by NEWMAP’s Ekiti State Communications Officer, Rotimi Feyisina, in Ado Ekiti on Sunday, said the Federal Government thumbed up Ekiti for the execution of notable projects including the construction of Ajolagun Bridge in Ikere, and the Arinkin Bridge in Ikole.

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Governor Laud Man for averting disaster in Delta state.

Delta State governor Ifeanyi Okowa on Sunday commended Ejiro Otarigho, a petroleum tanker driver, for his uncommon heroism that averted a major disaster.

Mr Otarigho, in a rare act of bravery, drove of the petroleum truck that exploded at Agbarho, Ughelli North Local Government Area on Saturday, away from the residential area.

The governor’s spokeman Olisa Ifeajika, in a statement in Asaba on Sunday, said the Agbarho-born driver’s bravery and patriotism-propelled risk saved what might have resulted in colossal loss of lives and property.

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Christian Association of Nigeria warn Against Muslim-Muslim ticket.

The Christian Association of Nigeria (CAN) has repeated its warning to the ruling All Progressives Congress (APC) and the opposition People’s Democratic Party (PDP) to bury the thought of Christian/Christian or Muslim/Muslim tickets for the 2023 presidential election.

CAN, in a statement by its national secretary, Mr Joseph Daramola, said a balance of practitioners of both religions should be considered in the choice of running mates of the presidential candidates.

It also congratulated the presidential candidates of the APC, the PDP and the Labour Party (LP), Senator Bola Tinubu, Atiku Abubakar and Mr Peter Obi, respectively, as well as other parties participating in the forthcoming election.

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Senator Shehu Sani says Good luck to Nigeria, if people want Nigeria to be like the present situation Kaduna of State

Nigeria former Senator Shehu Sani has taken to his verified Twitter page to say good luck to Nigeria, if people want Nigeria to be like the situation Kaduna State found itself.

The growing infamy of Kaduna as the most terrorized state in Nigeria in recent times is raising concerns in the security community.

Despite the state having some of the most critical military and police establishments in the country, the presence of terrorism continues to grow.

However, the outspoken activist, Shehu Sani who took to his Twitter handle some minutes ago speaks in a parable by saying Good luck to Nigeria, if Nigerians want to be in the situation Kaduna state has found itself.

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Precocious puberty is the term for puberty that begins much earlier than usual.

Definition

Precocious puberty is the term for puberty that begins much earlier than usual. Puberty is the process in which a child has a growth spurt and develops the sexual physical features of an adult.

In the brain, the hypothalamus releases chemicals (hormones) that cause the pituitary gland to release hormones called gonadotropins. Gonadotropins stimulate the growth of the sex glands (also called gonads), which in boys are the testicles, and in girls are the ovaries.

In boys, the testicles release testosterone; in girls, the ovaries release estrogen. Puberty usually starts between the ages of 8 and 13 in girls and 9 and 14 in boys.

Children affected by precocious puberty undergo this process much earlier: girls develop secondary sexual characteristics, like breasts, before age 8, and boys with precocious puberty have changed before age 9.

Precocious puberty

Epidemiology

Precocious puberty is commonly characterized as the development of secondary sex characteristics in girls before age 8 (or menarche before age 9), and in boys before age 9. The overall incidence of precocious sex is estimated to be between 1:5,000 and 1:10,000 babies. The ratio of females to males is approximately 10:1.

Types of Precocious puberty

There are 2 types of early puberty:

Gonadotropin-dependent: Also known as central precocious puberty, this is the most common type in both boys and girls. It’s caused by the early release of sex hormones (called gonadotropins) by the pituitary gland at the base of the brain. These hormones regulate puberty and sexual function.

Gonadotropin-independent: This is a type of early puberty that is not caused by the release of gonadotropins.

Precocious puberty Risk factors

Precocious puberty is more common in girls than in boys and occurs more often in African-Americans than in children of other races. Other risk factors may include:

Certain medical conditions (e.g., McCune-Albright syndrome, congenital adrenal hyperplasia)

Exposure to estrogen or testosterone hormones (e.g., pills, ointments)

Obesity

Previous radiation to the brain or spinal cord

The changes to your child’s body brought on by precocious puberty may cause him (or her) to feel self-conscious, and may also lead to teasing by peers. Counseling may help your child to work through these issues.

Tanner stages of development

Causes of Precocious puberty

Usually, early puberty has no identifiable cause. It happens earlier in certain ethnic groups such as Afro-Caribbean and South Asian.

Being overweight or obese can contribute to early physical maturation. In rare instances, precocious puberty may be due to other conditions. For example:

A structural anomaly in the brain (such as an abnormal growth or mass)

Brain injury due to head trauma

An infection (such as meningitis or encephalitis)

A problem in the ovaries, testes, adrenal gland or thyroid gland

A genetic disease affecting endocrine organs, bones and skin

Girls usually have no underlying medical problem; they simply start puberty early for unknown reasons. In boys, early puberty is less common and more likely to be associated with an underlying medical problem. Talk to your child’s doctor if sexual development is happening too soon.

Symptoms

The signs are secondary sexual characteristics that happen early.

Common signs in girls can include:

Breast growth

Pubic and underarm hair

Menstruation

Ovulation

Common signs in boys can include:

Enlarging penis and testicles

Pubic and underarm hair

Facial hair

Spontaneous erections

Production of sperm

Acne

Deepening of the voice

Other signs of the disorder include:

Moodiness

Increased aggression

Growing taller earlier than other classmates

The signs of precocious puberty can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

Facial hair growth

Complications

Psychological difficulties, including feeling, stressed, and becoming withdrawn because of the early physical changes. Poor self-esteem and bullying may be issues.

Behavioral problems and emotional problems.

Early puberty accelerates growth but bone maturation is also accelerated and so adult height is reduced.

Diagnosis and test

Our specialists in pediatric and adolescent gynecology start with a full health history and then perform a comprehensive physical exam. We may also order the following blood tests may be ordered to measure hormone levels including:

Luteinizing hormone (LH)

Follicle stimulation hormone (FSH)

A form of estrogen called estradiol

Thyroid hormones

Adrenal gland hormones

The following diagnostic tests may also help in diagnosis:

X-ray: The procedure uses a small amount of radiation in order to produce images of tissues inside the body. To measure your child’s bone age, an X-ray can be taken from the left hand and wrist. Bone age is sometimes, with precocious puberty, older than calendar age.

Ultrasound (sonography): This imaging test uses sound waves and a computer to create pictures of blood vessels, tissues, and organs. It helps physicians evaluate the uterus and ovaries.

Magnetic Resonance Imaging (MRI): This test uses large magnets and a computer to make detailed images of tissues in the body.

Precocious puberty treatment

If your child has precocious puberty, the doctor may refer you to a pediatric endocrinologist (a doctor who specializes in growth and hormonal disorders in children) for treatment.

The treatment goals are to:

Stop or even reverse sexual development

Stop the rapid growth and bone maturation that can lead to adult short stature or an early start to periods

Depending upon the cause, there are two possible approaches to treatment:

Treating the underlying cause or disease

Lowering the high levels of sex hormones with medicine to stop sexual development

Sometimes, treatment of a related health problem can stop the precocious puberty. But in most cases, there’s no other disease, so treatment usually involves hormone therapy to stop sexual development.

The currently approved hormone treatment is with drugs called LHRH analogs. These synthetic (man-made) hormones block the body’s production of the sex hormones that cause early puberty. Positive results usually are seen within a year of starting treatment. LHRH analogs are generally safe and usually cause no side effects in kids.

In girls, breast size may decrease. In boys, the penis and testicles may shrink back to the size expected for their age. Growth in height will also slow down to a rate expected for kids before puberty. A child’s behavior usually becomes more age-appropriate too.

Prevention of Precocious puberty

Much of the risk of precocious puberty is associated with gender, race, and family history, as well as other causes that are largely unavoidable, so you’re limited in what you can do to prevent this condition.

Keeping your child’s weight in a healthy range may help lower their risk of precocious puberty and other conditions associated with obesity and being overweight, such as type 2 diabetes.

You should also avoid giving your child prescription hormone medications, dietary supplements, or other products that may contain estrogen or testosterone unless prescribed or recommended by their doctor.

Nigeria:: (ASETU) condemned the result of APC and PDP Presidential Primary elections.

The Association of South East Town Union (ASETU) has condemned the outcome of the recently concluded Presidential Primary elections of the two major political parties: the All Progressives Congress, APC, and the Peoples Democratic Party, PDP.

It said the parties hatefully failed to produce a South-East presidential candidate, vowing to expose people they identified as Igbo saboteur delegates.

This was contained in a statement signed by Chief Emeka Diwe, the National President of ASETU, made available to DAILY POST on Friday.

Diwe said the outcome of the primaries vividly confirmed our continuous cry over the years through various press releases, communiques and other sundry publications regarding the sordid marginalization of Ndigbo within the Nigeria Polity.

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