Differential Diagnosis for Paronychia with Red Streak
- Single most likely diagnosis
- Bacterial paronychia: This is the most common cause of paronychia, often resulting from a bacterial infection, typically Staphylococcus aureus. The presence of a red streak suggests the spread of infection, which is consistent with bacterial paronychia.
- Other Likely diagnoses
- Fungal paronychia: Caused by fungal infections, this type can also present with redness and swelling, although it tends to be less acute than bacterial paronychia.
- Herpetic paronychia: Caused by the herpes simplex virus, it can present with pain, swelling, and sometimes a red streak, although vesicles are more characteristic.
- Irritant or allergic contact dermatitis: While not typically causing a red streak, severe cases can lead to significant inflammation that might be mistaken for an infectious process.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Necrotizing fasciitis: Although rare, this condition is a medical emergency. It can start with symptoms similar to paronychia but rapidly progresses to severe pain, swelling, and necrosis of the skin and underlying tissues.
- Osteomyelitis: Infection of the bone, which can occur if the infection spreads from the soft tissues around the nail. It requires prompt treatment to prevent serious complications.
- Sepsis: Any infection, including paronychia, can potentially lead to sepsis if not properly managed, especially in individuals with compromised immune systems.
- Rare diagnoses
- Paronychia due to other infectious agents (e.g., Mycobacteria, Blastomyces): These are less common causes of paronychia but should be considered in patients who are immunocompromised or have been exposed to specific pathogens.
- Erythema elevatum diutinum: A rare skin condition characterized by red, swollen, and tender lesions, which could potentially be mistaken for paronychia with a red streak in some cases.
- Sarcoidosis: Although extremely rare, sarcoidosis can cause skin lesions around the nails that might resemble paronychia.