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Suggest Treatment For Gout On Big Toe And Red Swollen Hot Sore
Question: I just tried send something and it kicked me out of program. So forgive me if this is a repeat. I was recently told by my doc that he thinks I have gout in big toe. But I don't agree. Toe was very inflamed a couple times recently for less than 24 hours. Not unbearable pain but definitely red, swollen, hot and sore. But now I notice discoloration of toenail and the base of my toenail seems to be separating. Could this be fungal infection?
Brief Answer:
it might be paronychia
Detailed Answer:
Hello.
Welcome to HCM.
This is Dr. Swarnava Dattagupta answering your query.
I have gone through your question and picture and understand your concern.
It looks like a case of paronychia or infection around a fingernail. The symptoms are suggestive of it, though in the earlier stages as significant pus has not formed. An associated fungal infection is not unlikely.
If such a patient comes to me, i would suggest a course of antibiotic with coamoxyclav for 5days, with a local antifungal cream application like terbinafine, proper cleanliness of the area and maintaining proper hygiene. A foot bath might be taken too.
If the swelling, pain and redness increases, a visit to a surgeon is advised as there can be accumulation of pus which should be taken out by incision and drainage.
However, an acute attack of gout has to be also ruled out and a blood test for blood sugar and uric acid needs to be done.
You can consult with your family doctor about this and for prescription of the above.
Hope this was useful.
Regards.
it might be paronychia
Detailed Answer:
Hello.
Welcome to HCM.
This is Dr. Swarnava Dattagupta answering your query.
I have gone through your question and picture and understand your concern.
It looks like a case of paronychia or infection around a fingernail. The symptoms are suggestive of it, though in the earlier stages as significant pus has not formed. An associated fungal infection is not unlikely.
If such a patient comes to me, i would suggest a course of antibiotic with coamoxyclav for 5days, with a local antifungal cream application like terbinafine, proper cleanliness of the area and maintaining proper hygiene. A foot bath might be taken too.
If the swelling, pain and redness increases, a visit to a surgeon is advised as there can be accumulation of pus which should be taken out by incision and drainage.
However, an acute attack of gout has to be also ruled out and a blood test for blood sugar and uric acid needs to be done.
You can consult with your family doctor about this and for prescription of the above.
Hope this was useful.
Regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your response. I have had a blood test for uric acid and it was normal. But the swelling and mild pain I experienced was weeks ago and has not returned. There is really no inflammation in the skin around the toenail, it is just the toenail itself. Not at all sore, puffy or anything. Given this information, would you still treat with antibiotics and cream? And do you think I will lose the toenail even though it does not feel like it is coming off?
Brief Answer:
antibiotics and cream should help
Detailed Answer:
Hello again.
Thank you for the detailed information.
It might be a low grade infection. And both in case of bacterial or fungal infection, the other can be present alongwith as a superadded infection.
So a course of antibiotics wont be harmful and rather would be helpful. Antifungal cream should be used alongwith.
As for the toenail, if it has started to discolour as it is seen in the picture, it is infected and might fall off on its own. But a new one would be grown in no time. It should not be a point of worry. It is better to remove an infected toe nail to avoid nail bed infection.
I will recommend you visit a surgeon / dermatologist and get this sorted.
Hope this helps.
Regards.
antibiotics and cream should help
Detailed Answer:
Hello again.
Thank you for the detailed information.
It might be a low grade infection. And both in case of bacterial or fungal infection, the other can be present alongwith as a superadded infection.
So a course of antibiotics wont be harmful and rather would be helpful. Antifungal cream should be used alongwith.
As for the toenail, if it has started to discolour as it is seen in the picture, it is infected and might fall off on its own. But a new one would be grown in no time. It should not be a point of worry. It is better to remove an infected toe nail to avoid nail bed infection.
I will recommend you visit a surgeon / dermatologist and get this sorted.
Hope this helps.
Regards.
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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