Montgomery Brett D
Hospital General Practice, Fremantle, Western Australia, Australia.
Aust Fam Physician. 2006 Oct;35(10):811, 813.
At first glance it seemed a minor problem, but the look on my new patient's face suggested otherwise. His finger had been painful for months and this week it had become worse. His swollen, erythematous nail fold, absent cuticle, and mildly dystrophic nail painted a typical picture of chronic paronychia. Assuming an acute bacterial superinfection, I prescribed a course of antibiotics, but my patient needed advice on treatment of the underlying condition. Another general practitioner had arranged fungal cultures, which had grown candida. Would antifungals be the best treatment? My patient and I agreed to meet in a week to assess his response to the antibiotics and to discuss treatment of the underlying chronic paronychia.
乍一看，这似乎是个小问题，但我这位新患者脸上的神情却表明并非如此。他的手指已经疼了好几个月，而这周情况变得更糟了。他那肿胀、发红的甲褶、没有角质层以及轻度营养不良的指甲呈现出典型的慢性甲沟炎症状。我认为是急性细菌性二重感染，便开了一个疗程的抗生素，但我的患者需要关于潜在病症治疗的建议。另一位全科医生安排了真菌培养，结果培养出了念珠菌。抗真菌药物会是最佳治疗方法吗？我和我的患者商定一周后见面，评估他对抗生素的反应，并讨论潜在慢性甲沟炎的治疗方法。
