Paronychia: Causes and treatment of an infected nail

Paronychia can result from biting or chewing the nails, but it is more common when working conditions require the hands to be frequently wet or exposed to chemicals.

Most cases of paronychia are not serious, and there are several effective treatments. This article will discuss the causes and treatments of the infection.

What is paronychia?

Paronychia is an infection of the skin around the nail of at least one finger or toe. It typically develops around the edges of the nail at the bottom or sides.

This skin infection causes inflammation, swelling, and discomfort around the nail. Abscesses containing pus can also form.

There are two types of paronychia:

• Acute paronychia. This develops over hours or days. The infection does not usually spread deep into the finger, and treatment can reduce symptoms relatively quickly.
• Chronic paronychia. This occurs when symptoms last for at least 6 weeks. It develops more slowly and can become more serious. Chronic paronychia often affects several digits at once.

Paronychia can occur at any age and is easily treatable.

In rare cases, the infection can spread to the rest of the finger or toe. If this happens, a person should see their doctor.

The infection occurs when the skin around the nail becomes damaged, allowing germs to enter.

Bacteria or fungi can cause paronychia, and common culprits are Staphylococcus aureus and Streptococcus pyogenes bacteria.

Common causes of skin damage around the nail include:

• biting or chewing the nails
• clipping the nails too short
• manicures
• excessive exposure of the hands to moisture, including frequently sucking the finger
• ingrown nails

Treatment

Treatments for paronychia will vary, depending on the severity and whether it is chronic or acute.

A person with mild, acute paronychia can try soaking the affected finger or toe in warm water three to four times a day. If symptoms do not improve, seek further treatment.

When a bacterial infection causes acute paronychia, a doctor may recommend an antibiotic, such as dicloxacillin or clindamycin.

When a fungal infection causes chronic paronychia, a doctor will prescribe antifungal medication. These medications are topical and typically include clotrimazole or ketoconazole.

Chronic paronychia may require weeks or months of treatment. It is important to keep the hands dry and clean throughout. If a person’s job requires their hands to be wet or exposed to germs, they may need to take time off.

A doctor may also need to drain any pus from surrounding abscesses. To do this, they will provide a local anesthetic, then open the nail fold enough to insert gauze, which will help drain the pus.

When to see a doctor

People can treat paronychia at home if symptoms are mild and the infection has not spread beyond the fingernail.

However, if symptoms do not improve after a few days or the infection has spread further than the nail, it is important to see a doctor.

If the symptoms are severe, contact a doctor immediately.

People can reduce their risk of developing nail infections by using the following methods:

• moisturizing after washing the hands
• avoiding biting or chewing the nails
• taking care when cutting the nails
• keeping the hands and nails clean
• avoiding submerging the hands in water for long periods
• avoiding contact with irritants
• keeping the nails short

Risk factors

Some people have a higher risk of paronychia, such as:

• women
• people with diabetes
• people whose hands are frequently wet, including cleaners
• people with other skin conditions, such as dermatitis
• people with weakened immune systems

Diagnosis

In most cases, a doctor can easily diagnose paronychia with a physical examination. They will also consider a person’s medical history and look for risk factors, such as diabetes.

In some cases, a doctor may require a sample of any pus that is present. They can send this to a laboratory for analysis to check whether bacteria or fungi are causing the infection.

Summary

Paronychia is a skin infection around a fingernail or toenail. Symptoms include inflammation, swelling, pain, and discomfort. Biting or chewing the nails is a common cause.

Acute paronychia develops quickly, and treatment can reduce symptoms rapidly. People can treat mild cases at home. Chronic paronychia has a slower onset and can take weeks for treatment to effectively reduce symptoms.

Taking good care of the hands and nails is the best way to prevent paronychia.

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