What is paronychia and how does it affect the nails? Explore the causes, symptoms, and treatment of this common nail condition with informative pictures.

Defining Paronychia

Paronychia is a localized skin infection that occurs around the nail fold, the area where the skin meets the nail. It can be acute, developing suddenly, or chronic, persisting for an extended period. This condition is quite common and often results from minor injuries or irritation to the nail fold, such as biting or picking at the skin around the nails.

Causes of Paronychia

Paronychia can be caused by a variety of factors, including:

• Bacterial infections: Staphylococcus and Streptococcus bacteria are the most common culprits, often entering through small cuts or cracks in the skin around the nails.
• Fungal infections: Candida, a type of yeast, can also cause paronychia, particularly in individuals with a weakened immune system or who are prone to fungal infections.
• Trauma: Repeated minor injuries to the nail fold, such as from biting, chewing, or picking at the skin, can lead to paronychia.
• Certain occupations: People who work with their hands, such as healthcare workers, hairstylists, or mechanics, are more prone to developing paronychia due to increased exposure to potential irritants and microbes.

Symptoms of Paronychia

The primary symptoms of paronychia include:

• Redness and swelling: The skin around the nail becomes red, inflamed, and may appear swollen.
• Pain and tenderness: The affected area is often painful to the touch and can be sensitive to pressure.
• Pus-filled blisters: In more severe cases, pus-filled blisters or abscesses may form around the nail.
• Nail changes: The nail may become thick, discolored, or distorted as the infection progresses.

Diagnosing Paronychia

Paronychia is typically diagnosed through a physical examination of the affected nail and surrounding skin. In some cases, the healthcare provider may collect a sample of the pus or fluid from the affected area for further testing to identify the specific cause of the infection.

Treating Paronychia

The treatment for paronychia depends on the underlying cause and the severity of the infection. Some common treatment approaches include:

• Antibiotics: Oral or topical antibiotics may be prescribed to treat bacterial infections.
• Antifungal medications: Antifungal creams or ointments may be used for fungal-related paronychia.
• Warm compresses: Applying warm, moist compresses to the affected area can help to reduce swelling and promote drainage of any pus or fluid.
• Drainage: In some cases, the healthcare provider may need to drain any accumulated pus or fluid from the affected area.
• Prevention: Proper nail and skin care, such as avoiding trauma to the nail fold and keeping the area clean and dry, can help prevent the development of paronychia.

Paronychia in Pictures

Explore the various stages and manifestations of paronychia through the following images:

1. Acute paronychia with redness, swelling, and pain around the nail fold.
2. Chronic paronychia with thickening and discoloration of the nail.
3. Paronychia in the toes, often accompanied by a fungal infection (tinea pedis).
4. Paronychia caused by an ingrown toenail, leading to inflammation and pus formation.
5. Paronychia in the finger, with visible swelling and redness around the nail.
6. Paronychia with the development of a pus-filled blister or abscess.
7. Paronychia affecting multiple fingers, indicating a more widespread infection.

Preventing Paronychia

To help prevent the development of paronychia, consider the following tips:

• Avoid biting, chewing, or picking at the skin around the nails.
• Wear gloves when engaging in activities that may cause trauma to the nail folds.
• Keep the hands and feet clean and dry, especially after activities that may introduce moisture or irritants.
• Treat any underlying skin conditions or infections promptly to prevent the spread of infection to the nail fold.
• Consult a healthcare provider if you experience any signs of paronychia, as early treatment can help prevent complications.

When to Seek Medical Attention

It’s important to seek medical attention if you experience any of the following signs and symptoms:

• Severe pain, redness, or swelling around the nail
• Pus-filled blisters or abscesses
• Fever or other signs of systemic infection
• Paronychia that does not improve with home treatment within a few days
• Recurrent or chronic paronychia that persists despite treatment

Timely diagnosis and appropriate treatment can help prevent the spread of infection and potential complications, such as the loss of the nail or the development of a deeper, more serious infection.

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Paronychia Information | Mount Sinai

Infection – skin around the nail

Paronychia is a skin infection that occurs around the nails.

Candida paronychia produced periungual erythema, edema and nail fold maceration.

A paronychia is an infection around the nail. Many organisms can cause a paronychia. This particular case is caused by the yeast-like organism Candida. Note the inflammation (red, swollen area) at the base of the nail and the changes that are apparent in the nail itself.

Causes

Paronychia is common. It is from injury to the area, such as biting off or picking a hangnail or from trimming or pushing back the cuticle.

The infection is caused by:

• Bacteria
• Candida, a type of yeast
• Other types of fungi

A bacterial and fungal infection can occur at the same time.

Fungal paronychia may occur in people who:

• Have a fungal nail infection
• Have diabetes
• Expose their hands to water a lot

Symptoms

Main symptom is a painful, red, swollen area around the nail, often at the cuticle or at the site of a hangnail or other injury. There may be pus-filled blisters, especially with a bacterial infection.

Bacteria cause the condition to come on suddenly. If all or part of the infection is due to a fungus, it tends to occur more slowly.

Nail changes may occur. For example, the nail may look detached, abnormally shaped, or have an unusual color.

If the infection spreads to the rest of the body, symptoms may include:

• Fever, chills
• Development of red streaks along the skin
• General ill feeling
• Joint pain
• Muscle pain

Exams and Tests

The health care provider can usually diagnose this condition by simply looking at the sore skin.

Pus or fluid may be drained and sent to a laboratory to determine what type of bacteria or fungus is causing the infection.

Treatment

If you have bacterial paronychia, soaking your nail in warm water 2 or 3 times a day helps reduce swelling and pain.

Your provider may prescribe oral antibiotics. In severe cases, your provider may cut and drain the sore with a sharp instrument. Part of the nail may need to be removed.

If you have chronic fungal paronychia, your provider may prescribe antifungal medicine.

Outlook (Prognosis)

Paronychia often responds well to treatment. But, fungal infections may last for several months.

Possible Complications

Complications are rare, but may include:

• Abscess
• Permanent changes in the shape of the nail
• Spread of infection to tendons, bones, or bloodstream

When to Contact a Medical Professional

Call your provider if:

• Paronychia symptoms continue despite treatment
• Symptoms worsen or new symptoms develop

Prevention

To prevent paronychia:

• Care for the nails and the skin around the nails properly.
• Avoid damaging the nails or fingertips. Because the nails grow slowly, an injury can last for months.
• Do not bite or pick the nails.
• Protect the nails from exposure to detergents and chemicals by using rubber or plastic gloves. Gloves with cotton liners are best.
• Bring your own manicure tools to nail salons. Do not allow the manicurist to work on your cuticles.

To minimize the risk for damage to the nails:

• Keep fingernails smooth and trim them weekly.
• Trim toenails about once a month.
• Use sharp manicure scissors or clippers for trimming fingernails and toenails, and an emery board for smoothing the edges.
• Trim nails after bathing, when they are softer.
• Trim fingernails with a slightly rounded edge. Trim toenails straight across and do not cut them too short.
• Do not trim cuticles or use cuticle removers. Cuticle removers can damage the skin around the nail. The cuticle is needed to seal the space between the nail and skin. Trimming the cuticle weakens this seal, which can allow germs to enter the skin and lead to infection.

Andre J, Sass U, Theunis A. Diseases of the nails. In: Calonje E, Brenn T, Lazar AJ, Billings SD, eds. McKee’s Pathology of the Skin. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 23.

Dinulos JGH. Nail diseases. In: Dinulos JGH, ed. Habif’s Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 25.

Leggit JC. Acute and chronic paronychia. Am Fam Physician. 2017;96(1):44-51. PMID: 28671378 pubmed.ncbi.nlm.nih.gov/28671378/.

Mallett RB, Banfield CC. Paronychia. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson IH, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 182.

Last reviewed on: 4/14/2021

Reviewed by: Elika Hoss, MD, Senior Associate Consultant, Mayo Clinic, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Paronychia is a purulent inflammation of the periungual fold and tissues at the base and sides of the nail. The main reason is infection under the skin as a result of trauma, prolonged exposure to chemicals, or non-compliance with personal hygiene. Also, complications of certain skin, infectious or endocrinological diseases can become the cause of paronychia.

There are several forms of paronychia:

• Tourniolus is the most common form of the disease, characterized by gradually increasing suppuration and an increase in painful symptoms. The form is characteristic of infectious paronychia caused by fungi of the genus Candida or streptococcal infection.
• Erosive and ulcerative forms – develop with syphilis, pemphigus, Duhring’s disease. They are characterized by the appearance of vesicles and ulcers on the skin around the nail, from which “ichor” or pus periodically seeps out. The pathological process often passes to the nail.
• Chronic paronychia is a long-term inflammatory process in which the cuticle may be completely absent, and the nail plate is often thickened or deformed. Chronic paronychia may result from prolonged exposure to chemicals.

Description and symptoms of paronychia

Paronychia begins with swelling and redness of the periungual fold. There is pain and a local increase in temperature. After a while, an abscess and accumulation of pus form.

Further course of the disease leads to spontaneous outpouring of pus from under the nail fold or under the nail plate. In the second case, the nail acquires a yellowish-green color. In some cases, the periungual roller is covered with whitish scales or crusts, ulcers or vesicles.

If left untreated, the disease becomes chronic, in which the nail thickens and deforms. There is a risk of complete loss of the nail plate. Also, the lack of treatment can be fraught with complications such as phlegmon, abscess, tissue necrosis, infection of the tendons, sepsis.

Diagnosis and treatment of paronychia

Only a surgeon can diagnose the disease. In most cases, a simple examination is enough to make a diagnosis. But in order to determine the cause of the disease, it may be necessary to conduct a general blood test, a blood test for sugar and a Wasserman reaction. To exclude a fungal infection, a biopsy of the nail plate is necessary (if the pathological process has affected not only the periungual tissues, but also the nail itself).

Because different causes and forms of paronychia require different treatments, it is recommended that you see a doctor as soon as the first symptoms appear. If treatment is started during the first 3 days from the onset of the disease, it is often possible to do without surgical intervention, using conservative therapy methods.

In case of suppuration, the abscess will need to be opened and drained using outpatient surgery methods. In the clinic of VERBA MEDICAL LLC, this is a minimally invasive operation, using modern ultrasound equipment. The operation can be performed immediately after the diagnosis is confirmed. The next day the patient can return to normal life. But a full recovery can take up to 3 weeks, depending on the causes and degree of the disease, during which observation by a surgeon is required.

To prevent serious complications, make an appointment with the surgeon of the clinic LLC “verba medical” Solodovnik A.V. or Chumak S.A. at the first signs of inflammation or swelling of the periungual tissues.

Treatment of paronychia of the finger on the hand

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Paronychia (paronychia) is a purulent inflammation localized at the base of the nail plate or under it, provoked by an infectious, bacterial or fungal infection. Surgeons of the medical center “KDS Clinic” treat paronychia using aspiration drainage. The method is used in the treatment of purulent surgical diseases with opening and removing the contents of abscesses from the body.

Preparation

The treatment of paronychia does not require any special preparation other than prior consultation with a specialist. During the reception, the surgeon examines the affected area, excludes the presence of foreign bodies or malignant tumors in the wound, and also prescribes a bacteriological analysis to determine the pathogen. After that, the correct treatment of paronychia of the finger is prescribed.

Methods of treatment of paronychia

Topical therapy can be prescribed at the initial stage of the development of the problem, consisting of the application of:

• ultrasound;
• electrophoresis;
• salt and soda baths;
• UHF therapy;
• drug therapy;
• radiotherapy;
• hypothermia.

In the absence of positive dynamics, the surgeon may decide on the need for surgical treatment of paronychia of the finger on the hand. To do this, the capsule of purulent inflammation is opened with a wedge-shaped, U-shaped or lateral dissection of the surface of the phalanx of the finger under local anesthesia. With the localization of suppuration under the nail plate, part or all of the nail is removed.

Use conventional surgical scalpel, laser machine, and radiosurgical equipment.

Rehabilitation period

The total rehabilitation period is 10-14 days, depending on the body’s ability to recover. In the first 2-3 days after the removal of the paronychia of the finger, a sterile bandage is recommended for the wound, which is changed once a day. Medications can also be prescribed to prevent the development of secondary inflammation.

Complications

If left untreated, paronychia of the nail plate can lead to abscess, necrosis of finger tissue, loss of the nail, finger, infection of the tendons, bones and blood.