Paronychia

Overview

What is paronychia?

Paronychia (say: "pare-oh-nick-ee-uh") is an infection in the skin around the fingernails or toenails. It usually affects the skin at the base (cuticle) or up the sides of the nail. There are two types of paronychia: acute paronychia and chronic paronychia. Acute paronychia often occurs in only one nail. Chronic paronychia may occur in one nail or several at once. Chronic paronychia either doesn’t get better or keeps coming back.

Symptoms

What are the symptoms of paronychia?

Typically, paronychia begins with pain, swelling and redness around the base or the sides of the nail. Acute paronychia can cause pus-filled pockets (abscesses) to form at the side or base of the fingernail or toenail.

Chronic paronychia may cause the cuticle to break down. This type of paronychia may eventually cause the nail to separate from the skin. The nail may become thick, hard and deformed.

Paronychia caused by bacteria can get worse quickly. Fungus-caused paronychia typically gets worse much more gradually.

Causes & Risk Factors

What causes paronychia?

Biting, chewing or picking at nails, pulling hangnails or sucking on fingers can increase the risk of getting an infection. An ingrown toenail can also cause paronychia.

Chronic paronychia can occur when nails are exposed to water or harsh chemicals for long periods of time. Moisture allows certain germs, such as candida (a type of fungus), and bacteria to grow. People whose hands may be wet for long periods of time are at higher risk for chronic paronychia. These may include bartenders, dishwashers, food handlers or housecleaners. Chronic paronychia may be caused by irritant dermatitis, a condition that makes skin red and itchy. Once the skin is irritated, germs can take hold and cause an infection.

Paronychia is more common in adult women and in people who have diabetes. People who have weak immune systems—such as people who must take medicine after having an organ transplant or people who are infected with HIV (human immunodeficiency virus)—are also at higher risk of getting paronychia.

Diagnosis & Tests

How can my doctor tell if I have paronychia?

Your doctor can diagnose paronychia with a simple physical exam. Special tests aren’t usually necessary, but your doctor may want to send a sample of fluid or pus to a laboratory to identify the bacteria or fungus that is causing the infection.

Treatment

How is paronychia treated?

Warm water soaks 3 to 4 times a day can help reduce pain and swelling if you have acute paronychia. Your doctor may prescribe antibiotics if your paronychia is caused by bacteria. He or she may prescribe antifungal medicines if your infection is caused by a fungus.

If you have a pus-filled abscess pocket, your doctor may need to drain it. Your doctor will numb the area, separate the skin from the base or sides of the nail, and drain the pus.

If you have chronic paronychia, it is important to keep your nails dry and protect them from harsh chemicals. You may need to wear gloves or use a skin-drying cream to protect skin from moisture. You may need an antifungal medicine or antibiotic, depending on what is causing the infection. You may need to apply a steroid cream or a solution made of ethanol (alcohol) and thymol (fungicide) to keep nails clean and dry.

Paronychia caused by a fungus can be hard to get rid of, so be patient and follow your doctor’s recommendations. If the infection does not clear up, be sure to tell your doctor.

Complications

What are the complications of paronychia?

Rarely, paronychia can cause permanent damage to your nail. If you have diabetes, there’s a risk that paronychia could spread to deeper tissues and bones, or into the bloodstream and other parts of the body. In extreme cases of deep infection, paronychia can result in the loss of fingers, toes or limbs.

Be sure to contact your doctor if:

  • Treatment doesn’t help your symptoms.

  • You have a fever or chills.

  • Red streaks appear on your skin, running from the infected area toward your body (for example, up your foot from your toes or up your hand or wrist from your fingers).

  • You have joint or muscle pain.

Prevention

How can I avoid getting paronychia?

The best away to avoid acute paronychia is to take good care of your nails.

You can avoid chronic paronychia by keeping your hands dry and free from chemicals. Wear gloves when working with water or harsh chemicals. Change socks at least every day, and do not wear the same shoes for two days in a row to allow them to dry out completely.

  • Avoid injuring your nails and fingertips.

  • Don’t bite or pick your nails.

  • Keep your nails trimmed and smooth.

  • Avoid cutting nails too short and don’t scrape or trim your cuticles, as this can injure the skin.

  • Use clean nail clippers or scissors.

Questions to Ask Your Doctor

  • Do I have paronychia?

  • What treatment is best for me?

  • What kind of paronychia do I have?

  • Is my paronychia caused by a bacteria?

  • Do I need to take an antibiotic?

  • Will my nail ever go back to normal?

  • I have diabetes. How can I clear up my paronychia?

  • Will I need surgery?

  • My symptoms aren’t getting better. When should I call my doctor?

  • I get ingrown toenails a lot. What can I do to prevent paronychia?