Paronychia: Symptoms, Causes, Diagnosis, and Treatment - Verywell Health
Paronychia is a common infection of the soft tissue bordering the fingernail or toenail. It is usually caused by bacteria that enters a break in the skin in these areas. Though it can be painful, most cases aren't serious if treated promptly.
Antibiotics are often necessary, and some people may also need to have pus drained from the infected tissue by their healthcare provider.
This article discusses the symptoms and causes of paronychia, how it is diagnosed and treated, and how you can reduce your risk of developing this infection.
Paronychia Symptoms
Paronychia symptoms are similar to those of other infections and may include:
- Redness
- Pain
- Tenderness
- Swelling
After a few days of these early symptoms, pus begins to collect under the skin or nail. This pus forms an abscess that can be drained.
What Causes Paronychia?
Any trauma that makes it easy for bacteria or fungi to enter the fleshy part of your finger or toe near the nail can lead to paronychia. This is commonly due to:
- Biting your nails
- Pulling or biting at a hangnail
- Pushing cuticles back during a manicure
Most bacteria that cause paronychia infections are found in the human mouth, and include bacteria that are aerobic (which need oxygen) and anaerobic (which don't need oxygen). Chief among these bugs are species of Staphylococcus aureus and Streptococcus.
Paronychia doesn't just affect healthy people. People with compromised or suppressed immune systems (such as those with HIV) may experience hard-to-treat chronic paronychia. Furthermore, people with diabetes can get chronic paronychia caused by fungi like Candida albicans.
Ongoing use of chemicals or detergents without wearing gloves can cause the skin to dry and crack, making it possible for a fungal or bacterial infection to take hold. Dishwashers and housekeepers frequently develop chronic paronychia when ongoing exposure to cleaning solutions and moisture compromises the nail and allows for infiltration by fungi.
Diagnosis
Paronychia is diagnosed by a physical exam, and does not usually involve cultures. Sometimes an X-ray may be used to look for a foreign body or evidence of bone infection (osteomyelitis), the latter of which may occur when paronychia is caused by a chronic fungal infection.
Paronychia Treatment
Though some mild cases of paronychia resolve on their own with simple to no treatment at home, others require antibiotics. Cases involving pus build-up may require a draining procedure.
Treating Paronychia at Home
At-home treatment of paronychia includes soaking the hand or toe a few times a day in warm water. This will help keep the area clean and may help the infection resolve on its own.
If you're still experiencing discomfort or notice your symptoms are worsening after a few days, contact your healthcare provider.
Medications
The antibiotics most commonly used to treat paronychia are Bactrim (TMP/SMX) and a cephalosporin named Keflex (cephalexin). Bactrim is especially effective against drug-resistant bacteria, including methicillin-resistant Staphylococcus aureus.
If your healthcare provider suspects anaerobic bacteria is causing your infection, they may use more than one medicine. Sometimes Evoclin (clindamycin) or Augmentin (amoxicillin-clavulanate) may be given along with Bactrim.
Procedures
In the infection is severe, your healthcare provider can also elevate the hardened bit of skin bordering the nail itself (eponychium) so that pus can be drained.
Alternatively, the doctor can directly slice into the fluctuant portion of the infection; this procedure is no different from draining an abscess or boil.
Sometimes paronychia can extend under part of the nail. In these cases, either part or all the nail needs to be removed. A paronychia that is left untreated can sometimes surround the entire nail margin and result in a "floating" nail.
After a paronychia is drained of pus, there is usually no need for antibiotics. However, if the paronychia is accompanied by localized cellulitis or skin infection, antibiotics are needed to treat the skin infection.
A Word From Verywell
Infections around your fingernail or toenail can be painful, but aren't necessarily serious. They can be treated by draining the abscess, or by taking antibiotics. Your healthcare provider will work with you to determine the best course of treatment.
The best treatment, though, is prevention. By protecting your hands when using harsh chemicals or detergents and avoiding behaviors like nail-biting or picking at hangnails, you can minimize your risk of developing paronychia. If you develop symptoms, talk to your healthcare provider about how best to treat the infection.
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