Patients usually develop a burning, pruritic sensation before the infection erupts. A physical exam shows vesicles and vesicopustules, along with pain and erythema. It is important to not confuse this with a felon or a paronychia as incision and drainage of herpetic whitlow could result in a secondary bacterial infection and failure to heal. Onychomycosis is a fungal infection of the nail that causes whitish-yellowish discoloration. Sometimes, it is difficult to treat and requires oral antibiotics instead of topical. Nail psoriasis  can affect the fingernails and toenails. It may cause thickening of the nails with areas of pitting, ridges, irregular contour, and even raising of the nail from the nail bed. Squamous-cell carcinoma is mainly cancer of the skin, but can also affect the nail bed. It is a rare malignant subungual tumor subject to misdiagnosis as chronic paronychia. Treatment
When no pus is present, warm soaks for acute paronychia are reasonable, though evidence to support its use is lacking.Chronic paronychia is treated by avoiding whatever is causing it, a topical antifungal, and a topical steroid. In those who do not improve following these measures, oral antifungals and steroids may be used or the nail fold may be removed surgically. Antibiotics
No strong evidence has been found to recommend topical vs. oral antibiotics, and this may be physician-dependent based on experience. Antibiotics used should have S. aureus coverage. Topical antibiotics used may be a triple antibiotic ointment, bacitracin, or mupirocin.
Chinese records also showed a huge outbreak in Mongolia in the early 1330s.In 2022, researchers presented evidence that the plague originated near Lake Issyk-Kul in Kyrgyzstan. The Mongols had cut the trade route (the Silk Road) between China and Europe, which halted the spread of the Black Death from eastern Russia to Western Europe. The European epidemic began with an attack that Mongols launched on the Italian merchants last trading station in the region, Caffa in the Crimea.In late 1346, plague broke out among the besiegers and from them penetrated the town. The Mongol forces catapulted plague-infested corpses into Caffa as a form of attack, one of the first known instances of biological warfare. When spring arrived, the Italian merchants fled on their ships, unknowingly carrying the Black Death. Carried by the fleas on rats, the plague initially spread to humans near the Black Sea and then outwards to the rest of Europe as a result of people fleeing from one area to another. Rats migrated with humans, traveling among grain bags, clothing, ships, wagons, and grain husks. Continued research indicates that black rats, those that primarily transmitted the disease, prefer grain as a primary meal. Due to this, the major bulk grain fleets that transported major citys food shipments from Africa and Alexandria to heavily populated areas, and were then unloaded by hand, played a role in increasing the transmission effectiveness of the plague. Third pandemic
The plague resurfaced for a third time in the mid-19th century; this is also known as "the modern pandemic".