Paronychia

Written by Mary Ellen Ellis | Published on July 25, 2012
Medically Reviewed by George Krucik, MD

Overview

Paronychia is an infection of the skin around fingernails and toenails. The infection can be caused by bacteria, a fungus, or a type of yeast (candida). It may also be a result of a combination of the three infecting agents. Depending on the cause of the infection, paronychia may come on slowly and last for weeks or arise suddenly and last for only a day or two. The symptoms of paronychia are easy to spot and can usually be easily and successfully treated with little to no damage to the skin and nails. If neglected, however, the infection can become severe and result in partial or complete loss of the nail.

Acute and Chronic Paronychia

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

Acute Paronychia

An acute infection almost always occurs around the fingernails, and its onset is very quick. It is usually the result of damage to the skin around the nails from biting, hangnails, manicures, and other physical trauma. Staph bacteria are the most likely infecting agent in the case of acute paronychia.

Chronic Paronychia

A chronic infection can occur on the fingers or toes and comes on slowly. It lasts for several weeks and often comes back. It is typically caused by more than one infecting agent, often candida yeast or a fungus plus bacteria, and is more common in people who are constantly exposed to a moist environment.

What Are the Symptoms of Paronychia?

The symptoms of both acute and chronic paronychia are very similar. They are largely distinguished from each other by the speed of onset and the duration of the infection. Chronic infections come on slowly and last many weeks, while acute infections are quick and do not last long. Both infections have the following symptoms:

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

What Causes Paronychia?

There are multiple causes of both acute and chronic paronychia. The underlying cause of each is one or more infecting agents: bacteria, yeast, and fungus.

Acute Paronychia

An acute infection is typically caused by a bacterial agent that is introduced to the area around the nail by some type of trauma. This can be from biting at the nails or hangnails, puncture by manicurist tools, pushing down the cuticles too aggressively, and other similar types of injuries.

Chronic Paronychia

The underlying agent of infection in chronic paronychia is most commonly the candida yeast, but it can also be a fungus and bacteria. Because yeasts and fungi grow well in moist environments, this infection is often caused by having feet or hands in water much of the time.

How Is Paronychia Diagnosed?

In most cases, your doctor can diagnose your infection simply by observing it. If the infection does not respond to a treatment, however, your doctor may take a sample of the fluids from the infected area for a lab test. This will determine the exact infecting agent and will allow your doctor to prescribe the best treatment.

How Is Paronychia Treated?

With mild cases of acute paronychia, you can treat it successfully at home by soaking the infected area in hot water a few times a day and by applying antibiotic ointment. If the infection is more severe or does not respond to home treatment, your doctor may prescribe an oral antibiotic. You may also need to have blisters or abscesses cut and drained of fluids to relieve discomfort and speed healing.

Chronic paronychia is more difficult to treat. You will need to see your doctor, as home treatment is not likely to be successful. Your doctor will probably prescribe an anti-fungal medication and advise you to keep the area dry. In severe cases, you may need surgery to remove part of the nail.

How Can Paronychia Be Prevented?

Good hygiene is important to preventing paronychia. By keeping hands and feet clean, you can prevent bacteria from getting between your nails and skin. You can also prevent acute infections by avoiding trauma to the nail area, which can be caused by biting at nails or by getting a manicure or pedicure.

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

What Is the Long-Term Outlook for Paronychia?

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

The prognosis for chronic infections is not as good, as the fungal infection is likely to last longer, for weeks or months. Still, with treatment, it should eventually clear up.

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