Localized infections in acute wounds, such as paronychia and minor abscesses, are common presentations in UK primary care settings. Effective assessment and management are crucial to prevent complications and ensure optimal patient outcomes.
Paronychia
Paronychia is an inflammation of the tissue surrounding the nail, which can be acute or chronic. Acute paronychia typically presents with rapid onset of pain, erythema, and swelling around the nail fold, often following minor trauma or nail-biting. The primary causative organisms are Staphylococcus aureus and streptococci.
Assessment: Clinically, acute paronychia is identified by tenderness, redness, and swelling of the lateral or proximal nail folds. An abscess may be evident as a localized collection of pus.
Management: Initial treatment involves warm soaks to promote drainage. Topical antibiotics, such as mupirocin, may be applied, especially if bacterial involvement is suspected. If an abscess is present, incision and drainage are indicated. Oral antibiotics are generally reserved for cases with extensive cellulitis or for immunocompromised patients.
Minor Abscesses
Minor abscesses are localized collections of pus within tissues, commonly resulting from bacterial infections. Patients typically present with localized pain, swelling, erythema, and fluctuance.
Assessment: Physical examination reveals a tender, fluctuant mass with overlying erythema. Systemic symptoms are usually absent in minor cases.
Management: The primary treatment is incision and drainage under appropriate aseptic conditions. Routine use of antibiotics is not necessary unless there is surrounding cellulitis, systemic symptoms, or in immunocompromised individuals. Proper wound care post-drainage is essential to promote healing.
Criteria for Referral
Primary care practitioners should consider referral to secondary care in the following scenarios:
Infections not responding to initial management.
Rapidly spreading cellulitis or systemic involvement.
Involvement of critical structures, such as tendons or joints.
Recurrent infections indicating an underlying condition.
Early recognition and appropriate management of localized infections in acute wounds are vital in primary care. Adhering to evidence-based practices ensures effective treatment and timely referrals when necessary.
Enhance Your Skills
For healthcare professionals seeking to improve their competence in managing minor injuries and acute wounds, Practitioner Development UK Ltd offers the following courses:
Minor Injury Essentials: This RCN-accredited course provides comprehensive training in assessing, diagnosing, and managing minor injuries in urgent and primary care settings.
Acute Wound Management for Urgent & Primary Care Practitioners: This workshop equips practitioners with essential skills for effective assessment and treatment of acute wounds and infections, including hands-on experience in suturing and other closure techniques.
These courses are designed to enhance clinical proficiency and ensure adherence to current best practices in wound management.
References
Roberts, D. B. (2017) ‘Acute and Chronic Paronychia’, American Family Physician, 96(1), pp. 44-51.
Saxena, A. and Bawa, M. (2022) ‘Acute and Chronic Paronychia Revisited: A Narrative Review’, Journal of Cutaneous and Aesthetic Surgery, 15(2), pp. 91-98.
Singer, A. J., & Talan, D. A. (2014). ‘Management of skin abscesses in the era of methicillin-resistant Staphylococcus aureus‘. New England Journal of Medicine, 370(11), 1039-1047.
