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Paronychia

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.

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Types

Acute and chronic paronychia

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.

Symptoms

Symptoms of paronychia

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
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Causes

Causes of paronychia

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.

Diagnosis

How paronychia is diagnosed

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.

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Treatments

How paronychia is treated

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.

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Prevention

How paronychia can be prevented

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.

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Outlook

Long-term outlook

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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