Paronychia (Nail Infection)

What is paronychia?

Paronychia is an infection of the skin next to a fingernail or toenail.

How does it occur?

The cutting or tearing of a hangnail or cuticle, nail biting, or a splinter or thorn prick can cause a break in the skin near the nail. Bacteria or a fungus can then get into the skin and infect it.

Common skin bacteria such as staphylococcus and streptococcus are the usual causes of acute paronychia, which is a sudden painful infection. Paronychia that develops slowly (chronic paronychia) is usually caused by a fungus, such as Candida, rather than bacteria.

You have a higher risk of having chronic paronychia if:

• You have diabetes.
• Your job involves a lot of exposure to water or chemical solvents. Examples of such jobs are housecleaning, nursing, food service, and dishwashing.
• You bite your nails.

What are the symptoms?

The skin near the nail is:

• red
• irritated
• swollen
• painful.

If you have acute paronychia, the redness may get worse over a couple of days and a pocket of cream-colored fluid or pus may form. This pocket of infection is called an abscess.

The symptoms of chronic paronychia are milder than the symptoms of acute infection but they do not go away. If you have the infection for a long time, the nail may become thick and hard.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you.

How is it treated?

For an infection caused by bacteria your healthcare provider may prescribe an antibiotic. For a fungal infection, your provider may prescribe an antifungal cream.

If you have had the infection for a while and an abscess has formed, your healthcare provider may numb your finger or toe and then cut the pocket open to drain the pus. If the infection is beneath the nail, your provider may remove a section of the nail. Your provider may pack the wound with gauze to allow it to drain and heal.

How long will the effects last?

Usually it takes about a week for acute paronychia to heal. You may need to treat a fungal infection for several weeks with antifungal medicine before it heals.

How can I take care of myself?

The best time to take care of a nail infection is as soon as it starts to develop.

• Wash the infected area with soap and water and rinse it thoroughly.
• Soak your finger or toe in warm water or put a warm compress on the infected area. (You can use a washcloth that has been soaked with hot water.) This will help speed up healing.
• Put an antibiotic ointment on the area and cover it with a bandage.

Once the infection has formed an abscess, then the only effective treatment is to cut open and drain the infection. You should see your healthcare provider to have this done.

It is safe to take nonprescription pain medicines if you are not allergic to them and have no other reason to avoid them (such as harmful side effects). If you are unsure about which pain medicine you can take, ask your healthcare provider.

How can I help prevent paronychia?

• Do not pick at your nails or cut the cuticles.
• Don’t bite your nails.
• If you want to push the cuticles of your nails back, use clean instruments and be careful not to push too hard.
• Wear gloves if your work or daily activities put your hands at risk for getting scratched, poked, or irritated.
• If you have nail infections often, be sure to get checked for diabetes.