Overview

Paronychia is an infection of the skin around your fingernails or toenails, specifically where the nail meets the skin (the nail fold). It happens when germs, usually bacteria or sometimes fungi, get under the skin through a small break, like a cut, hangnail, or from biting your nails.

Anyone can get paronychia, from young children who suck their thumbs to adults who frequently have their hands in water or get manicures, and elderly individuals with more fragile skin. Acute (sudden) paronychia is generally not contagious from person to person, but the bacteria or fungi causing it can spread if there's direct contact with pus from an infected area. Chronic (long-lasting) paronychia is also not typically contagious. Living with paronychia, especially if it's chronic or recurrent, can be quite uncomfortable and sometimes painful, making everyday tasks a bit more challenging.

Symptoms

You might notice several signs if you have paronychia:

• Redness and swelling - around the edge of your nail. This is often one of the first things you'll see.
• Pain or tenderness - when you touch the affected area. It might feel warm too.
• Formation of a pus-filled blister - (abscess) under the skin next to the nail. This is more common in acute paronychia.
• Changes in the nail itself, such as thickening, discoloration (often yellowish or greenish), or separation of the nail - from the nail bed. This is more typical with chronic paronychia.
• The skin around the nail might feel boggy or soft - especially with chronic cases.
• Mild itching can sometimes occur, particularly with fungal causes.
• Symptoms of acute paronychia usually appear suddenly and can worsen quickly.
• Chronic paronychia symptoms develop more slowly, over weeks or months, and may come and go.

Diagnosis

Diagnosing paronychia is usually straightforward for a healthcare professional. They will likely:

• Examine the affected nail and surrounding skin carefully. They'll look for the classic signs like redness, swelling, and any pus.
• Ask about your symptoms - how long you've had them, and any activities that might have caused it (like recent manicures, nail biting, or frequent hand washing).
• In some cases, especially if there's pus or if the infection isn't getting better, your doctor might take a small sample of the pus or a skin scraping. This sample can be sent to a lab to identify the specific bacteria or fungus causing the infection. This helps confirm the diagnosis and guide treatment if needed.

Management & Treatment

Dealing with a painful, swollen finger or toe can be worrisome, but the good news is that paronychia is very treatable. The right approach depends on whether it's a sudden (acute) issue or a long-lasting (chronic) one. For many mild cases, you can start to find relief with simple care at home.

Home Care & Self-Management

For mild, acute paronychia without a collection of pus (an abscess), you can often manage symptoms at home.

• Warm Soaks: Soaking the affected finger or toe in warm water for 10-15 minutes, 3-4 times a day, is a cornerstone of treatment. This can help reduce pain and swelling and may encourage a small infection to drain on its own.
• Keep It Clean and Dry: After soaking, gently pat the area completely dry. For chronic paronychia, keeping the nail folds dry and protected from moisture is the most important step to allow the skin to heal.
• Avoid Irritants: If you have chronic paronychia, protecting your hands from harsh soaps, detergents, and prolonged water exposure is key. Wear waterproof gloves with a cotton liner when doing dishes or working with chemicals.

Over-the-Counter (OTC) Options

While there aren't specific OTC medications to cure paronychia, you can use antibiotic ointments on a minor cut or hangnail to help prevent an infection from starting. Applying a thick moisturizer or barrier cream can also help protect the skin and allow chronic paronychia to heal by restoring the skin's protective barrier.

When Prescription Treatments Are Needed

If home care isn't enough, or if your symptoms are getting worse, it's time to see a healthcare provider.

• Acute Paronychia: If there are signs of a bacterial infection, such as increasing redness, warmth, or the formation of an abscess, your doctor will likely prescribe topical or oral antibiotics. If an abscess has formed, a provider may need to perform a simple in-office procedure to drain the pus, which provides immediate relief.
• Chronic Paronychia: Since chronic paronychia is often related to inflammation and sometimes a fungal infection, treatment is different. Your doctor may prescribe a topical steroid cream to reduce the inflammation and/or a topical antifungal cream to treat yeast. It can take several weeks or even months for chronic paronychia to resolve.

Lifestyle Changes and Tips

• Nail Care: Be gentle with your nails. Avoid cutting or pushing back your cuticles, and don't bite your nails or pick at hangnails.
• Moisturize: Regularly use a hand cream, especially after washing your hands, to keep the skin from getting dry and cracked.
• Protect Your Hands: If your hands are frequently in water, find a good pair of waterproof gloves. This is the most effective way to prevent chronic paronychia from recurring.

It’s important to follow your doctor's advice carefully. With acute paronychia, you should see improvement within a few days of starting treatment. For chronic cases, be patient, as it can take a few months for the nail fold to heal completely.

If the redness starts to spread up your finger, you develop a fever, or the treatment doesn't seem to be working, be sure to contact your healthcare provider right away.

Duration & Outlook

The timeline for paronychia depends on whether it's acute or chronic. Acute paronychia, if addressed promptly, often improves within a few days to a week. Without proper care, it can sometimes worsen or lead to a more significant collection of pus.

Chronic paronychia, on the other hand, can be a more persistent issue, lasting for six weeks or longer, and may come and go over months. With consistent care and avoidance of triggers, chronic paronychia can be managed, but it may take time for the nail and surrounding skin to return to normal. Most cases of paronychia resolve well, but it's important to watch for warning signs of complications, such as the infection spreading further up your finger or toe, severe pain, fever, or red streaks moving away from the infected area.

Prevention

Preventing paronychia often comes down to good nail and hand care:

• Avoid biting your nails - or picking at the skin around them.
• Be gentle when trimming your nails. Don't cut cuticles too short or push them back aggressively.
• Keep your hands and feet clean and dry. If your hands are frequently wet (e.g., from washing dishes or certain jobs), try to wear waterproof gloves.
• Moisturize your hands and cuticles regularly - especially after washing, to prevent skin from cracking.
• If you get manicures or pedicures, ensure the salon uses sterilized instruments.
• Avoid sharing nail clippers or other personal care tools.

Causes & Triggers

Paronychia is caused by an infection, usually when germs enter through a break in the skin around the nail.

• Acute paronychia - is most often caused by bacteria (like Staphylococcus aureus) getting into a small injury, such as a cut, a torn hangnail, from nail biting, or after an aggressive manicure.
• Chronic paronychia - is often caused by a fungus (like Candida albicans) or sometimes a mix of fungi and bacteria. It’s more common in people whose hands are frequently wet or exposed to irritants.
• Triggers include:
  • Nail biting or picking at cuticles
  • Frequent hand washing or exposure to water and detergents
  • Manicures or pedicures, especially if cuticles are damaged
  • Ingrown nails
  • Thumb sucking in children
  • Certain medical conditions like diabetes or a weakened immune system can make you more prone to infections.
• People who work as dishwashers, bartenders, healthcare workers, or swimmers are often more likely to develop chronic paronychia due to frequent moisture exposure.

When to see a doctor

While mild paronychia might sometimes improve on its own with good home care, it's important to see a healthcare professional if you notice:

• Significant pain, redness, or swelling - that isn't getting better after a day or two.
• The presence of pus or an abscess - (a tender, pus-filled bump).
• Red streaks - spreading from the infected area up your finger or toe – this could be a sign the infection is spreading.
• Fever or chills - along with the nail symptoms.
• If you have diabetes or a weakened immune system - it's best to see a doctor sooner rather than later for any signs of infection.
• If the condition is chronic - (lasting more than 6 weeks) or keeps coming back.
• If you're unsure what's causing the problem or how to care for it.

A dermatologist is a specialist in skin and nail conditions and can provide an accurate diagnosis and discuss appropriate management if your primary care doctor feels it's necessary, or if the condition is severe or persistent.

Frequently Asked Questions (FAQs):

• Q: Is paronychia serious? Most cases of acute paronychia are not serious if cared for properly. However, if left untreated, the infection can worsen or spread. Chronic paronychia can be very persistent and frustrating. It's always best to monitor it and see a doctor if you're concerned.
• Q: Can I get paronychia from a nail salon? Yes, it's possible. If instruments aren't properly sterilized or if cuticles are cut or pushed back too aggressively, it can create an entry point for infection. Always choose reputable salons that follow strict hygiene practices.
• Q: Will my nail fall off if I have paronychia? In severe or chronic cases of paronychia, the nail can sometimes become damaged, discolored, or even separate from the nail bed. However, this is not common with mild, acute cases that are addressed promptly.
• Q: Is acute paronychia different from chronic paronychia? Yes. Acute paronychia usually starts suddenly, is often caused by bacteria, and is characterized by pain, redness, and sometimes pus. Chronic paronychia develops more slowly, often involves fungal infection (or a mix), and causes persistent swelling, tenderness, and nail changes. It typically lasts six weeks or longer.
• Q: What happens if I don't do anything about paronychia? If an acute bacterial paronychia isn't managed, the infection could worsen, leading to a larger abscess, more pain, or rarely, spread to deeper tissues. Chronic paronychia will likely persist or worsen, causing ongoing discomfort and nail damage.

We understand that dealing with any skin or nail condition can be worrying. This information is here to help you understand paronychia better. Please remember, if you have concerns about your skin or nails, it's always a good idea to consult with a healthcare professional for an accurate diagnosis and guidance.

References

• American Academy of Family Physicians. (2017). Acute and Chronic Paronychia. Retrieved from https://www.aafp.org/pubs/afp/issues/2017/0701/p44.html
• Harvard Health Publishing. (n.d.). Paronychia. Retrieved from https://www.health.harvard.edu/a_to_z/paronychia-a-to-z
• Leggit, J. C. (2017). Acute and Chronic Paronychia. American Family Physician. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28671378/
• DermNet NZ. (n.d.). Paronychia. Retrieved from https://dermnetnz.org/topics/paronychia