Paronychia is an infection of the skin around the fingernails and toenails. Bacteria or a type of yeast called Candida cause this infection. Bacteria and yeast can even combine into 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.
One of the most common infections of the hand is paronychia that may present as acute or chronic condition.
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 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 bacteria, Candida yeast, or a combination of the two agents.
A bacterial agent that’s introduced to the area around the nail by some type of trauma typically causes an acute infection. This can be from biting your nails or hangnails, being punctured by manicurist tools, pushing down your cuticles too aggressively, and other similar types of injuries.
Most commonly it results due to finger sucking, nail biting, a hang nail, aggressive manicuring, penetrating trauma in which the foreign body is or is not retained. With the development of paronychia, sculptured fingernail placement is also shown to be associated. Staphylococcus aureus is the most common infecting organism. Even other organisms such as streptococci and pseudomonas may cause the infection.
There have been reports of even gram negative organisms such as dermatophytes and herpes simplex virus to be causative agents. Patients with acute paronychia report of tenderness of the perionychium and localized pain. Spontaneously the symptoms may arise or after the trauma or manipulation of nail bed the symptoms may show.
Usually there is appearance of inflamed and erythematous perionychial area and the nail may be distorted or discolored. Pus may get collected if the condition is left untreated. At the nail margin, fluctuance and local purulence may occur and beneath the nail margin the infection may extend. When the pus gets accumulated the nail plate may get elevated.
The underlying agent of infection in chronic paronychia is most commonly Candida yeast, but it can also be a 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.
Clinically this condition resembles acute paronychia but it has multifactorial causes. Usually chronic paronychia is non-suppurative and treatment is more difficult. Those who are repeatedly exposed to moist environment or those who are exposed to irritants present in water are at a risk of developing chronic paronychia. Bartenders, homemakers, housekeepers, dishwashers, diabetics, swimmers and people who are immunosuppressed are at high risk of developing chronic paronychia.
There have been reports of breast cancer spread to the lateral nail fold of the great toe. Hence when chronic paronychia does not respond to conventional treatment, benign and malignant neoplasm should always be ruled out. Usually in chronic paronychia the nail folds become boggy, red, tender and swollen. For six weeks or longer the symptoms may be present. Fluctulance and erythema is rare.
Often after exposure to water or moist environment episodically, swelling, pain and inflammation may occur. Eventually there is thickening of nail plates and with they developed pronounced transverse ridges and they become discolored. From the nail plate the cuticle and nail fold may separate. Thus the microbes may get space to enter and invade.
If scraping is taken and a wet mounting is done with potassium hydroxide then hyphae is seen or in bacterial and fungal elements hyphae may be shown by purulent discharge. In chronic paronychia there have been implications of gram-negative cocci, atypical mycobacteria and gram-negative rods.
The following are the paronychia risk factors:
- Any trauma to the nail
- Nail trimming
- Job wherein frequently your hands and nails are exposed to water or solvents
- You can be prone to many infections, if you have diabetes
When to seek medical care for a paronychia?
If beyond the skin around the nail the redness extends then call a health care provider. Seek help if the redness extends to the pad of the finger. This redness could be a sign that the nail infection if becoming a serious finger infection. In the deep tissues of the fingertip pus is being formed. This is known as felon.
If an abscess if forming then call a health care provider. The doctor will need to do drainage of the pus. This drainage of the pus that is done by opening the abscess should not be tried at home. For possible drainage seek medical attention at the first sign of pus collection. Immediately go to the hospital’s emergency department if you notice that down the finger the redness and swelling has extended or if you are not able to move the joints of the finger that is affected. This condition may or may not be accompanied by other symptoms such as chills or fever. If it does it could indicate a serious infection.
In most cases, a doctor can diagnose paronychia simply by observing it.Your doctor may send a sample of the tissue 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. You can soak the infected area in hot water several times per day and apply antibiotic ointment. Your doctor may prescribe an antibiotic to take by mouth if the infection is more severe or if it isn’t responding to home treatments. 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’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 the nail.
It is recommended that by doing an incision and drainage procedure, drain the patients abscess if an abscess has formed. Most likely medication such as lidocaine will be prescribed by the doctor. This medication helps to numb the entire first finger and by using a surgical knife the doctor will open the abscess. Sometimes in the abscess a packing called a wick is placed.
This is so that when the patient goes home the abscess can be allowed to drain and it prevents it from closing and thus prevents the abscess from reforming. Usually for 24-48 hours the packing is left. Sometimes if the case is severe then under the patient’s fingernail the infection can move. In such a case partial or complete nail removal can be needed. Unless there is no serious infection that is spreading onto the digits, antibiotic treatment is not needed.
To check for the type of bacteria involved in the infection, a doctor may or may not take a culture of the drainage. After the paronychia has been drained, it is still recommended to do warm soaks at home. If the infection is involving around the nail bed more of the finger then usually medications such as antibiotics are only prescribed. Sometimes bacitracin is recommended. It is a topic antibiotic. It is important that in 24-48 hours after the treatment you follow up with your doctor. This is just to ensure that healing is taking place properly.
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, manicures, or pedicures can also help you prevent acute infections.
Avoid biting your fingernail and if you are engaging in moisture type exposure or frequent hand washing then wear rubber gloves. Chronic illness such as diabetes should be kept under control. If you are working in dirt or carpentry then wash your hands frequently. If you are doing any job in which there is chance if cuts, scrapes or you hand is getting soiled, then wash your hands frequently.
You can care at home by soaking your affected finger or toe in warm water. Also you can make a mixture of 50 percent liquid antibacterial soap and 50 percent warm water and soak your affected finger or toe in that daily 3-4 times for about 15 minutes. At the first sign of redness around the nail this soaking should be done. You should see the doctor once any abscess is visible.