Overview

What is a nail infection paronychia?

Paronychia is an infection involving the skin around your fingernails and toenails. It is caused by bacteria most commonly or fungus called Candida. Sometimes, at the same time even, bacteria and Candida can infect the same area.

Depending on what causes the infection, paronychia can appear slowly with symptoms that may last for weeks, or it can come up very quickly with symptoms that can only last for one or two days. The signs of paronychia are easily observed, and usually your condition will be easily diagnosed and treated without any severe damage to your skin or nails. Your infection can lead to great severity and even full or partial loss of your nail if it is not treated properly.

There are two types of paronychia. Both have similar symptoms and signs:

Acute paronychia: Symptoms of acute paronychia appear within a few hours or days. The infection is only in the nail fold. It does not extend further into the finger or toe. Symptoms are less than six weeks and resolve with treatment.
Chronic paronychia: Symptoms take longer to develop than for acute paronychia and tend to last six weeks or longer. Many fingers or toes may become infected at the same time. A secondary nail fungus typically occurs; it is usually caused by one of the types of fungi known as candida.

What are symptoms of a nail infection (paronychia)?

Symptoms of paronychia typically appear within several hours or days. In a few cases, they may take longer to appear. Symptoms tend to be located at the nail fold and cuticle areas where the nail meets the skin. The nail sides can also be affected.

Symptoms of paronychia include:

Pain, swelling, and tenderness surrounding the nail
Skin that is warm to the touch and is red.
Necrotic material collects under the skin. A white to yellow, pus-filled abscess can develop. If an abscess is present, it may need antibiotics and/or drainage.

The nail may begin to grow with irregular shapes and ridges or waves if untreated. The color of the nail may become yellow or green. The nail will be dry and brittle. It may even separate from the nail bed and falling off.

What causes paronychia?

Infectious paronychia most commonly results from a staph infection. Staph infections are caused by the presence of Staphylococcus aureus bacteria. Other bacteria (including Streptococcus pyogenes) also cause the infection. Bacteria enter the skin through:

Cuts, broken skin or hangnails.
Ingrown nails (this most often occurs with ingrown toenails).
Irritation from water or chemicals.
Trauma to the nailbed or cuticle area. Trauma may be due to accidental injury, nail biting, and frequent manicures or pedicures.
In some cases, the cause of paronychia may not be due to bacterial infection but from some medications. Such medications include retinoids, anti-cancer drugs, HIV medications, and certain antibiotics.

How is paronychia diagnosed?

Your doctor will question you on your symptoms and perform a physical exam. In most cases, doctors do not require ordering any tests to confirm the diagnosis of nail infection. The doctor may take a sample of the infected tissue to send to the laboratory to test for specific infectious causes such as bacteria or fungi. Usually, if the infection is serious, imaging test, such as X-ray may be required to check the involvement of bone underneath.

What is the treatment for paronychia?

Antibiotic drugs usually cure most bacterial nail infections. These antibiotics kill bacteria that cause an infection. Be sure to follow your doctor's instructions and complete the full course of antibiotics so that the infection doesn't recur.

If pus has formed around the nail bed and is not draining on its own, your doctor will drain the pus. Your doctor cleans the area and then makes a small cut so that the pus can drain from your body. The provider places a bandage over the cut. Keep the area clean and change the bandage as necessary.

Can I prevent nail infections (paronychia)?

To prevent acquiring a nail infection you should:

Avoid biting, chewing, or picking at your nails and hangnails. Likewise, do not pick at your cuticles.
Be gentle not to cut your nails too short. When cutting cuticles, avoid cutting them close to the nail fold.
Good hygiene practice involves washing hands and keeping your nails clean. You have to use mild soaps that will not easily irritate your skin.
Apply moisturizer to your nail fold and cuticles when you have dry skin. Extreme dryness can cause cracking.
Wear rubber gloves if you need to have contact with any form of chemicals or your hands will be soaked for an extended period of time.

What is the outlook for patients with paronychia?

The infection usually resolves with treatment. Some people get more than one infection or the infection recurs after treatment (chronic paronychia). If left untreated, the infection may eventually damage the nail.

Untreated paronychia can, in some instances, extend into the finger or toe and becomes a serious infection. Infection may extend to involve the bone underneath. Doctors have to remove an entire finger or toe in a few cases to keep the infection contained so it does not spread. It's a cause of cases of severe, chronic paronychia and is particularly common among people with diabetes or with conditions that impair the normal flow of blood.

When to call your doctor about paronychia?

If you have diabetes or another condition that affects your blood circulation, or are immunosuppressed, call your provider immediately. If you have a condition that weakens your body's ability to fight infection, seek immediate care.

Call your doctor if symptoms are severe or do not improve within a few days. If symptoms recur after treatment, you should contact your doctor for an assessment.