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This image displays redness and swelling around the cuticle of the nail typical of early paronychia. Paronychia, commonly known as bacterial nail infection, is inflammation of the region of the finger or toe from which the nail plate originates, which is called the proximal nail fold (PNF). Bacterial nail infection most often affects the proximal nail fold of the fingers and less commonly affects the toes. For acute paronychia, the doctor may: Puncture and drain the affected area and test for bacteria or viral infection. This Site and third parties who place advertisements on this Site may collect and use information about your visits to this Site and other websites in order to provide advertisements about goods and services of interest to you. If you would like to obtain more information about these advertising practices and to make choices about online behavioral advertising, please click here. Episodic dermatolymphangioadenitis (DLA) in patients with lymphedema of the lower extremities before and after administration of benzathine penicillin: a preliminary study. Periorbital and orbital cellulitis before and after the advent ofHaemophilus influenzae type B vaccination.
Microbiology of perianal cellulitis in children: comparison of skin swabs and needle aspiration. A bacteriologically controlled, randomized study comparing the efficacy of 2% mupirocin ointment (Bactroban) with oral erythromycin in the treatment of patients with impetigo. Double-blind, double-dummy comparison of azithromycin and cephalexin in the treatment of skin and skin structure infections. Therapy of serious skin and soft tissue infections with ofloxacin administered by intravenous and oral route. A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection. This inflammation may occur in the short term (acute) or may be a long-term problem or one that keeps coming back (chronic).
Viral paronychia occurs more often in adults and may be seen with genital herpes infection or in people who work in health care.Chronic paronychia is most common in adult women and those who work in places where their hands are kept moist, such as food handlers. Common skin infections include cellulitis, erysipelas, impetigo, folliculitis, and furuncles and carbuncles.
Cellulitis commonly occurs near breaks in the skin, such as surgical wounds, trauma, tinea infections (Figure 1), or ulcerations, but occasionally presents in skin that appears normal.
Anthony's fire, usually presents as an intensely erythematous infection with clearly demarcated raised margins, and often with associated lymphatic streaking (Table 1).
The nonbullous type predominates and presents with an erosion (sore), cluster of erosions, or small vesicles or pustules that have an adherent or oozing honey-yellow crust. Commonly known as an abscess or boil, a furuncle is a tender, erythematous, firm or fluctuant mass of walled-off purulent material, arising from the hair follicle.

A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Acute paronychia develops along a break in the skin and is usually seen at the side of the nail.
Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species.
Common sites are the legs and face.15 Most cases do not have an inciting wound or skin lesion and are preceded by influenza-like symptoms.
The most common form is superficial folliculitis that manifests as a tender or painless pustule that heals without scarring.24 The hair shaft will frequently be seen in the center of the pustule. These lesions may occur anywhere on the body, but have a predilection for areas exposed to friction. Current antibiotic recommendations include penicillinase-resistant penicillins, first-generation cephalosporins, azithromycin, clarithromycin, amoxicillin-clavulanic acid, or a second-generation fluoroquinolone in the skeletally mature patient. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. This type of nail infection is often caused by a bacterial infection but may also be caused by herpes, a type of viral infection.
Erysipelas is a superficial form of cellulitis with sharply demarcated borders and is caused almost exclusively by Streptococcus.
It often ruptures leaving a complete or partially denuded area with a ring or arc of remaining bulla (Figure 5). Multiple or single lesions can appear on any skin bearing hair including the head, neck, trunk, buttocks, and extremities. Gram-negative coverage with a second-, third-, or fourth-generation cephalosporin is usually indicated in children under three years and in patients with diabetes or who are immunocompromised. Impetigo is also caused by Streptococcus or Staphylococcus and can lead to lifting of the stratum corneum resulting in the commonly seen bullous effect.
However, most physicians treat this infection the same as cellulitis, which is outlined earlier. Nonbullous impetigo was previously thought to be a group A streptococcal process and bullous impetigo was primarily thought to be caused by S. When the infection is bacterial rather than mechanical in nature, it is most commonly caused by Staphylococcus. Marking the margins of erythema with ink is helpful in following the progression or regression of cellulitis (Figure 2). Typically, the furuncle will develop into a fluctuant mass and eventually open to the skin surface, allowing the purulent contents to drain, either spontaneously or following incision of the furuncle.Carbuncles are an aggregate of infected hair follicles that form broad, swollen, erythematous, deep, and painful masses that usually open and drain through multiple tracts. If the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle stages and usually requires incision and drainage.

Outpatient therapy with injected ceftriaxone (Rocephin) provides 24 hours of parenteral coverage and may be an option for some patients. Constitutional symptoms, including fever and malaise, are commonly associated with these lesions but are rarely found with furuncles. All of these infections are typically diagnosed by clinical presentation and treated empirically. Topical therapy with erythromycin, clindamycin, mupirocin, or benzoyl peroxide can be administered to accelerate the healing process.25Staphylococci will occasionally invade the deeper portion of the follicle, causing swelling and erythema with or without a pustule at the skin surface.
If antibiotics are required, one that is active against gram-positive organisms such as penicillinase-resistant penicillins, cephalosporins, macrolides, or fluoroquinolones should be chosen. Children, patients who have diabetes, or patients who have immunodeficiencies are more susceptible to gram-negative infections and may require treatment with a second- or third-generation cephalosporin. However, because the lesions of bullous impetigo can be large and both forms of impetigo can have satellite lesions, an oral antibiotic with activity against S.
This inflammation of the entire follicle or the deeper portion of the hair follicle (isthmus and below) is called deep folliculitis. Bacterial skin infections are the 28th most common diagnosis in hospitalized patients.1 Cellulitis, impetigo, and folliculitis are the most common bacterial skin infections seen by the family physician.
Haemophilus influenzae type b (Hib) in young children was a significant concern until the widespread use of the Hib vaccine and coverage with a parenteral third-generation cephalosporin was used routinely. Oral antibiotics are usually used in the treatment and include first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and fluoroquinolones.Gram-negative folliculitis usually involves the face and affects patients with a history of long-term antibiotic therapy for acne. Knowledge of the presentation, histopathology, and microbiology for each type of infection is important for proper care of the patient. Presenting signs and symptoms of glomerulonephritis include edema and hypertension; about one third of patients have smoky or tea-colored urine. Multiple pustular or papular perifollicular lesions appear on the trunk and sometimes extremities within six to 72 hours after exposure (Figure 6), and mild fever and malaise may occur. Streptococcal glomerulonephritis usually resolves spontaneously although acute symptoms and problems may occur.22Impetigo can be spread by direct person-to-person contact, so appropriate hygiene is warranted.
Ninety percent of patients presented with dermatitis, 78 percent with itching, 52 percent with rectal pain, and 35 percent with blood-streaked stools.
Despite 10 days of oral antibiotics (primarily penicillin or erythromycin), the recurrence rate was high at 39 percent.

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