Surgery may be used as a final resort in the most severe or treatment-resistant cases, though most procedures are considered experimental due to the limited literature on their side effects. Without treatment, OCD often lasts decades.Obsessive–compulsive disorder affects about 2.3% of people at some point in their lives, while rates during any given year are about 1.2%. It is unusual for symptoms to begin after age 35, and around 50% of patients experience detrimental effects to daily life before age 20. Males and females are affected equally, and OCD occurs worldwide. The phrase obsessive–compulsive is sometimes used in an informal manner unrelated to OCD to describe someone as excessively meticulous, perfectionistic, absorbed, or otherwise fixated. Signs and symptoms
OCD can present with a wide variety of symptoms. Certain groups of symptoms usually occur together; these groups are sometimes viewed as dimensions, or clusters, which may reflect an underlying process. The standard assessment tool for OCD, the Yale–Brown Obsessive Compulsive Scale (Y-BOCS), has 13 predefined categories of symptoms. These symptoms fit into three to five groupings. A meta-analytic review of symptom structures found a four-factor grouping structure to be most reliable: a symmetry factor, a forbidden thoughts factor, a cleaning factor, and a hoarding factor. The symmetry factor correlates highly with obsessions related to ordering, counting, and symmetry, as well as repeating compulsions. The forbidden thoughts factor correlates highly with intrusive and distressing thoughts of a violent, religious, or sexual nature. The cleaning factor correlates highly with obsessions about contamination and compulsions related to cleaning.
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.