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.

Paronychia: Causes, Symptoms, and Diagnosis

Overview

Paronychia is an infection of the skin around your fingernails and toenails. Bacteria or a type of yeast called Candida typically cause this infection. Bacteria and yeast can even combine in one infection.

Depending on the cause of the infection, paronychia may come on slowly and last for weeks or show up suddenly and last for only one or two days. The symptoms of paronychia are easy to spot and can usually be easily and successfully treated with little or no damage to your skin and nails. Your infection can become severe and even result in a partial or complete loss of your nail if it’s not treated.

Paronychia can be either acute or chronic depending on the speed of onset, the duration, and the infecting agents.

Acute paronychia

An acute infection almost always occurs around the fingernails and develops quickly. It’s usually the result of damage to the skin around the nails from biting, picking, hangnails, manicures, or other physical trauma. Staphylococcus and Enterococcus bacteria are common infecting agents in the case of acute paronychia.

Chronic paronychia

Chronic paronychia can occur on your fingers or toes, and it comes on slowly. It lasts for several weeks and often comes back. It’s typically caused by more than one infecting agent, often Candida yeast and bacteria. It’s more common in people who’re constantly working in water. Chronically wet skin and excessive soaking disrupts the natural barrier of the cuticle. This allows yeast and bacteria to grow and get underneath the skin to create an infection.

The symptoms of both acute and chronic paronychia are very similar. They’re largely distinguished from each other by the speed of onset and the duration of the infection. Chronic infections come on slowly and last for many weeks. Acute infections develop quickly and don’t last long. Both infections can have the following symptoms:

• redness of the skin around your nail
• tenderness of the skin around your nail
• pus-filled blisters
• changes in nail shape, color, or texture
• detachment of your nail

There are multiple causes of both acute and chronic paronychia. The underlying cause of each is bacteria, Candida yeast, or a combination of the two agents.

Acute paronychia

A bacterial agent that’s introduced to the area around your nail by some type of trauma typically causes an acute infection. This can be from biting or picking at your nails or hangnails, being punctured by manicurist tools, pushing down your cuticles too aggressively, and other similar types of injuries.

Chronic paronychia

The underlying agent of infection in chronic paronychia is most commonly Candida yeast, but it can also be bacteria. Because yeasts grow well in moist environments, this infection is often caused by having your feet or hands in water too much of the time. Chronic inflammation also plays a role.

In most cases, a doctor can diagnose paronychia simply by observing it.

Your doctor may send a sample of pus from your infection to a lab if treatment doesn’t seem to be helping. This will determine the exact infecting agent and will allow your doctor to prescribe the best treatment.

Home treatments are often very successful in treating mild cases. If you have a collection of pus under the skin, you can soak the infected area in warm water several times per day and dry it thoroughly afterward. The soaking will encourage the area to drain on its own.

Your doctor may prescribe an antibiotic if the infection is more severe or if it isn’t responding to home treatments.

You may also need to have blisters or abscesses drained of fluids to relieve discomfort and speed healing. This should be done by your doctor in order to avoid spreading the infection. When draining it, your doctor can also take a sample of pus from the wound to determine what is causing the infection and how best to treat it.

Chronic paronychia is more difficult to treat. You’ll need to see your doctor because home treatment isn’t likely to work. Your doctor will probably prescribe an antifungal medication and advise you to keep the area dry. In severe cases, you may need surgery to remove part of your nail. Other topical treatments that block inflammation may also be used.

Good hygiene is important for preventing paronychia. Keep your hands and feet clean to prevent bacteria from getting between your nails and skin. Avoiding trauma caused by biting, picking, manicures, or pedicures can also help you prevent acute infections.

To prevent a chronic infection, you should avoid excessive exposure to water and wet environments and keep your hands and feet as dry as possible.

The outlook is good if you have a mild case of acute paronychia. You can treat it successfully, and it’s unlikely to return. If you let it go untreated for too long, the outlook is still good if you get medical treatment.

Chronic infection is likely to last for weeks or months. This can often be more difficult to manage. So early treatment is important.

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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 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.

Green nail syndrome – causes, symptoms, treatment and prevention

August 06, 2021

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Almost every one of us faced different problems with nails. Ribbing, delamination, discoloration are the most common of them. Often the nail turns green – this means that one of the infections has got into the nail plate: a virus, bacterium or fungus. The treatment in each case is different, so you need to “know the enemy by sight” and be able to fight him.

Causes of green nail syndrome

The most common causes of green nails are:

Traumatic injuries

As a result of microtrauma or bruising, blood accumulates under the nail, soaking the soft tissues. At first, the skin becomes purple-cyanotic, with time it becomes green, and then yellowish. This is a natural process that should not be interfered with. If the cause of the problem is an injury, over time, the nail plate will again acquire a uniform healthy shade.

Fungi of the subspecies Candida

They do not damage the nail plate itself, but parasitize under it, causing a whole range of unpleasant symptoms, including greening of the nail. The cause of infection is a weakened immune system, because this fungus in a small amount always lives on the mucous membranes of the body. When natural defenses fail, pathogens become active.

Fungi of the genus Aspergillus

They multiply on the surface of the nail, causing visible damage, discoloration and an unpleasant smell.

Bacterial infections

One of the most common pathogens is Pseudomonas aeruginosa. This is the most dangerous pathogen that can even lead to death, spreading throughout the body.

Pseudomonas aeruginosa or Pseudomonas – the most common “culprit” of green nails

Pseudomonas live in the external environment, the human body is in constant contact with them. In the case of a weakened immune system, pathogen cells are activated, which leads to the development of green nail syndrome and a number of other problems. When Pseudomonas enters the nail cavity, it begins to multiply, forming a greenish-blue pigment, as a result of which the nail plate turns marsh-green. Spots can occupy both the entire nail and part of it, localized on one or more fingers.

Pseudomonas aeruginosa develops in the nail plate in two ways:

• Only in the upper part. This is visible to the naked eye: green spots are located in the outer layers of the nail, without affecting the soft tissues and without being accompanied by other symptoms. A person has no pain, onycholysis. To fix the problem in this case, it is enough to cut off the top layer of the nail.
• Getting into deep soft layers under the plate. In this situation, in addition to greening, burning, itching, suppuration, exfoliation of the nail, and the spread of infection to the cuticle zone join the symptoms of the pathology. Bacteria multiply rapidly – it takes 2-3 days for Pseudomonas to get into the blood.

Causes of Pseudomonas getting into the nail plate

The fact that the bacterium is on the surface of a healthy nail will not turn green. In the vast majority of cases, Pseudomonas infection occurs when extended nails are detached and air pockets form under them. Once there, pathogen cells begin to multiply actively. The problem arises due to non-compliance with the technological conditions of extension:

• insufficient degreasing of the nail plate before the procedure;
• ignoring the application of a primer that provides a sufficient level of adhesion of natural and artificial nails;
• insufficient treatment of the nail with a buff, as a result of which areas with a natural shine remain on the plate;
• non-compliance with the technology of correction of extended nails and incomplete removal of the old layer of the nail, as a result of which air pockets remain in place, and a new layer of gel is simply “poured” from above.

Also, risk factors that can cause Pseudomonas aeruginosa to enter the nail plate are:

• Detachment of the nail, inflammation of the periungual fold, damage to the cuticle, destruction of the nail plate under the influence of external or internal factors.
• Prolonged exposure to moisture on the nail plate.
• Prolonged wearing of extended nails.
• Regular contact with aggressive chemicals, the ground without protective gloves.
• Permanent trauma to the nail plate.
• Contact with Pseudomonas aeruginosa carriers.

Pathology treatment methods

Elimination of the problem of green nails is carried out in two ways and depends on the stage of development of the pathology.

Superficial stage

If there are small superficial green spots on one or more nails of the client, proceed as follows:

• Treat hands with antiseptic.
• Remove the artificial material with a cutter or file down to the natural nail plate. Here, the MAX manicure vacuum cleaner will be an excellent assistant – it does its job perfectly, protecting the master and the client from microparticles of harmful substances and materials getting into the lungs and eyes. The company manufactures professional accessories used by thousands of professionals around the world.
• Spread a paper towel or napkin on the table, file down the affected area with a disposable file to a healthy layer. If the client experiences pain, the manipulation must be stopped. The pain indicates that the pseudomonad has penetrated into the deep layers of the nail, and one cannot do without consulting a dermatologist.
• Throw away the file, napkin, treat the client’s hands and your own with an antiseptic.
• Take a cotton pad, moisten it with plenty of antiseptic, apply to the affected area.
• Additionally, you can treat the problem area with a slice of fresh lemon. Acid neutralizes Pseudomonas aeruginosa, and also neutralizes the remnants of green in the nail plate.
• After all disinfecting measures, it is necessary to apply an acid primer on the nail and wait for it to dry completely.
• Upon completion of the procedure, a new decorative coating can be applied in compliance with all antiseptic treatment measures and relevant technologies.

Some manufacturers produce preparations intended for salon treatment of nail plates affected by Pseudomonas. They have proven effectiveness, so experts recommend that all manicure masters acquire such tools.

Deep stage

Antibacterial treatment is indispensable in this case. It should be prescribed exclusively by a doctor – a person may have an individual intolerance to the drug. If the case is complex, both topical antibiotics and oral medications will be prescribed. The doctor will make the correct treatment and give recommendations that will make the therapy as effective as possible.

On average, drug treatment lasts 2-3 weeks. In advanced cases, therapy lasts up to 4 months. During this period, it is necessary to regularly visit a doctor who will monitor the dynamics of treatment, if necessary, adjust the prescribed drugs.

It is important to understand that green nail syndrome can be caused not only by bacteria, but also by fungi. That is why it is so important to contact a dermatologist – he will conduct an examination, take a nail sample for analysis, identify the cause of the development of the pathology, and then prescribe treatment. It is not recommended to purchase antifungal and antibacterial drugs on your own: they can not only be ineffective, but even harm the body.

Folk remedies

There are a number of folk remedies that will help you deal with Pseudomonas aeruginosa faster. It is recommended to use them in combination with medical treatment and only after prior consultation with a doctor:

Rubbing tea tree oil into the affected nail. The substance has a proven bactericidal effect.

Alcohol compresses. They quickly and effectively kill bacteria in the upper layers of the nail plate.

Vinegar bath, 1 tablespoon of acid to 250 ml of warm water. The procedure should be performed 4 times a day for 5 minutes.

Preventing nail problems

Treating green nail syndrome is not an easy task. Therefore, it is easier to follow the basic principle of preventive medicine and prevent the problem, rather than deal with it.

There are a number of general recommendations to help avoid fungal or bacterial infection of the skin and nail plate:

• Use only your own shoes and do not wear someone else’s, even at a party.