Paronychia: Nail Infection
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What is paronychia?
When the skin around your fingernails or toenails gets infected, it’s called paronychia.
The skin next to the nail is called the nail fold. Most of the time, paronychia is caused by bacteria (usually Staphylococcus aureus) that gets into the nail fold. Sometimes it can be from a yeast, like Candida. Either way, the skin of your nail folds becomes red and inflamed.
With paronychia, the nail fold might get red, swollen, and be painful. Sometimes, a little pocket of pus called an abscess might form.
Most cases of bacterial paronychia will get better in less than a week once you start treating it. Sometimes, paronychia caused by yeast can last for 6 weeks or more.
What does paronychia look like?
If there are painful blisters (white, clear, fluid-filled bubbles) on the skin surrounding the nail that keep recurring, it may be a herpes virus skin infection called whitlow. If there is a red, bleeding bump in the nail fold, this may be a pyogenic granuloma—a non-cancerous growth made of blood vessels. Both should be treated by a doctor. —Dr. Lauren Levy
Usually, the nail fold located on the edge or bottom of the fingernail or toenail becomes inflamed.
Inflammation makes the skin swollen, red, and very painful. It might fill with pus, look yellow or white, or feel like it’s full of fluid.
If you get paronychia infections often, you might lose your cuticle (the transparent skin located above and around the bottom nail fold). This causes the hard portion of the nail (known as the nail plate) to lift from the surrounding skin.
The nail may fall off after the infection, but it usually grows back once the infection is under control. If the infection is chronic, the nail itself might become thicker, discolored, or brittle.
- Swelling of nail folds
- Pus-filled abscesses
- Nail changes including: thickening, discoloration, and brittleness
- Loss of cuticle
Causes of paronychia
The nail infection happens when bacteria or yeast enter the skin around the nail through an opening. That can be caused by trauma to the nail (like aggressive cutting of the cuticles or skin around the nails) or through some kind of tear or cut. It can also happen if your skin is often wet from a job like dishwashing. The common types of infection are:
Bacterial is the most common cause of paronychia.
Bacterial paronychia usually causes an abscess around the nail, redness, and pain. The bacteria can enter the nail through a cut in the skin or from a dirty manicure tool. The types of bacteria that cause this infection are
- Staphylococcus aureus (“staph”) is the most common infection.
- MRSA (methicillin-resistant staph aureus) is a type of staph that may need special antibiotics.
Yeast usually causes a paronychia that is more chronic with redness and scaling around the entire finger nail.
- Candida is usually the cause.
- You are less likely to have an abscess.
- Chronic wet hands can make you susceptible to this condition.
- More likely to be a yeast infection if it lasts for 6 weeks or longer.
How do you treat paronychia?
Paronychia can be painful and needs to be treated. If you don’t treat it, your whole nail fold can become infected and you can lose the nail.
In the worst case, the infection can spread through the blood or to the bone in the finger (osteomyelitis). This can cause a more serious infection that could require surgery.
If you think you have a nail infection, see your doctor or a dermatologist or go to an urgent care center. The doctor will take your medical history and do a physical exam to see if there is a pocket of pus. They may ask you about your profession or the frequency of manicures. You probably won’t need blood tests to diagnose paronychia.
Bacterial paronychia treatment
If you have a pocket of fluid, your doctor will cut and drain the wound (called incision and drainage—or “I&D”). They will first give you something to numb the finger, like a lidocaine injection.
After it’s drained, they’ll squirt saline solution into the wound to clean it and will pack it with gauze. Your doctor may take a swab of the pus (a culture) and send it to the lab to identify what kind of bacteria or yeast caused the infection.
After the drainage, you will need to soak your finger or toe in warm water for 10 to 15 minutes, 3 times a day, until the infection is gone. Soaking is also how you treat the infection if you don’t need it to be drained.
Your doctor might give you antibiotics, topical (to apply directly to the nail bed), or oral. It depends on how bad the infection is. Take the entire course, even if symptoms go away.
- Topical antibiotics: These include over-the-counter ointments like triple ointment (Neosporin) and bacitracin, or prescription medications like mupirocin.
- There are several oral antibiotics your doctor can prescribe depending on the type of infection.
Yeast paronychia treatment
If there is no pocket of pus, but chronic redness around the nail, your doctor will recommend the use of an antifungal cream to be applied to the nail. Your doctor may ask you to wear gloves while working with water like when washing dishes.
- Topical antifungals, like clotrimazole or ketoconazole cream.
- People with weakened immune systems, such as those with HIV, diabetes, or those taking drugs that affect the immune system (immunosuppressives), are at increased risk.
- Those working as dishwashers, bartenders, or housekeepers may be at a higher risk.
- Manicures and pedicures can also put you at risk.
- Ingrown finger or toe nails increase the risk of infection.
Children and paronychia
Children are just as likely as adults to get nail infections. Sometimes, childhood behaviors like thumb-sucking or nail-biting can create the infection. If you think your child has it, take them to see their pediatrician. The doctor may cut open the pus pocket and may give your child antibiotics like Clinidamycin or amoxicillin-clavulanate (Augmentin).
It is not contagious. You can change your child’s diaper or hold your loved one's hand. However, you may want to bandage the area to prevent oozing or leakage. —Dr. Levy
A bacterial infection should start to improve within 24 to 48 hours of treatment. If it doesn’t, call your doctor.
Yeast paronychia will start to improve within a few days but may take up to 6 weeks. You should follow up with your doctor in 6 to 8 weeks to check for improvement.
Over trimming the nail cuticle can predispose you to paronychia. The cuticle protects us from infection. I usually recommend pushing back the cuticles rather than cutting them. —Dr. Levy
- Keep your hands dry and wear gloves while doing any wet work.
- Don’t suck your thumb or bite your nails.
- Wash your hands thoroughly.
- Clean and bandage cuts and scrapes around the nails.
- Make sure all manicure tools are clean and sterile.
This is a treatable condition. It will get better with simple treatments and behavioral changes like the way you cut your nails (preventing the nail from going into the fold) or wearing gloves when exposing your hands to water.
William C. Fix is a resident physician specializing in dermatology at the Albert Einstein College of Medicine and Montefiore Medical Center in New York. He graduated from Brown University with a BA in Economics in 2012 and obtained his MD from the University of Pennsylvania Perelman School of Medicine in 2019. William has received grants from the American Society for Dermatologic Surgery, The National Institutes of Health and the Alex’s Lemonade Stand Foundation for oncology research, and was selected for the University of Pennsylvania’s Dermatology Oncology Center (PennDOC) Research Fellowship in Dermatology & Dermatologic Surgery. William’s interests include general and procedural dermatology, cutaneous oncology, technology, and quality improvement.