化脓性甲沟炎

　　本病多由葡萄球菌感染所致，亦有白色念珠菌或其他细菌引起者。多继发于局部外伤、撕裂，嵌甲挫伤、逆剥(肉刺)或剪甲过深等损伤。水浸过久、各种理化性刺激以及长期应用皮质类固醇或免疫抑制剂等均易发生本病。

　　慢性甲沟炎可产生肉芽肿。对于严重感染病例，细菌可经感染灶进入血液循环系统，造成脓毒血症而并发高热、气促、心慌以及其他组织器官的化脓性并发症。细菌感染及其代谢产物可以直接损伤心肌导致，心肌炎引起心电图T波、ST段和P-R间期改变，见于10％～20％病例。

　　急性甲沟炎多由葡萄球菌和念珠菌感染所致。而化脓性甲沟炎多是急性甲沟炎治疗不及时导致的化脓性炎症。

　　1、急性甲沟炎
　　初起甲沟轻度红肿、疼痛及压痛，有的可自行消退，有的化脓，且可演变为甲周围炎或甲下脓肿，疼痛加剧，甲下见有黄色脓液积聚，甲与基底部分离。

　　2、慢性甲沟炎
　　病程慢性，拖延旬日，甲沟有轻度红肿、疼痛、甲小皮剥脱，少量脓液由甲沟流出，甲的边缘和甲沟处变黑，且可逐渐产生结节状或蕈状突起的炎症肉芽组织，不时分泌出脓液，易擦伤出血，部分甲受损，甲变形缩小，甲上有纵脊或横沟，甲下有脓液潜行，严重时，甲可以完全松动脱落。

　　化脓性甲沟炎的预防及护理注意以下几点：
　　1、在易于发生脓皮病的单位(如某些工厂、农机站、小学校等)中广泛进行有关防治化脓性皮肤病的宣传教育工作，定期进行预防检查，尽可能消灭一切发病因素。
　　2. Pay attention to personal hygiene, strengthen physical exercise, and enhance the resistance of the skin.
　　3. Maintain the integrity of the skin function. For skin diseases, especially pruritic skin diseases, timely and reasonable treatment should be carried out. Prevent skin injury, avoid scratching and skin friction, etc.
　　4.禁止公用衣帽、毛巾、面盆等，以防止接触传染，对病人适当进行隔离。病人所用的敷料及接触物要严格消毒或焚毁。在患病期间，除应用药液清洗皮损外，禁止用自来水洗涤患部，以防扩散。
　　5. Abstain from drinking alcohol or eating spicy and stimulating foods during the onset. Eat less rich food.

　　Suppurative paronychia can be diagnosed clinically through skin examination. During laboratory blood routine examination, the total white blood cell count and the count of neutrophils in peripheral blood are increased. Auxiliary examinations exclude other diseases, such as X-ray examination, etc.

　　After treatment, patients with suppurative paronychia are recommended to follow a high-protein diet, as high-protein diet is essential for maintaining healthy nails. Eggs are a good source of protein; oatmeal, nuts, seeds, grains, and dairy products are rich in plant protein; eat more vegetables and fruits. Eat more foods rich in vitamins B, C, D, E, and iron; avoid drinking alcohol or eating spicy and stimulating foods, and eat less rich food.

　　Suppurative paronychia often requires surgical treatment, longitudinally incising the posterior nail fold, and removing pus. The part or all of the nail should be removed depending on the extent of infection. The following points can be referred to for drug treatment:
　　1. General treatment: Eliminate the cause, and take corresponding protective measures for those caused by physical and chemical stimulation. For those caused by Candida albicans, take antifungal drugs; for those caused by bacteria, antibiotics can be used.
　　2. Local treatment: For acute paronychia, the affected area and limb should be elevated with a bandage in the early stage, and then the affected area should be coated with pure ichthammol. For severe pain, a ring block with procaine hydrochloride can be used. When there are eczematous changes, they should be treated as eczema. For those caused by ingrown toenails, nail avulsion can be performed.
　　3. Chronic paronychia has a long course and can produce granulomas.