Paronychia: What You Need to Know

Published September 16th, 2021 by Chris Riley
Fact Checked by
Jacqueline Hensler
Medically Reviewed:
Camille Freking

Causes of Paronychia | Types of Paronychia | Symptoms of Paronychia | How is it diagnosed | Treatment Options | How to prevent

Many people are unaware that paronychia is a nail infection. The word comes from the Greek word "paronykhia" which is in turn derived from two Greek words meaning “beside” and “nail.” Paronychia usually affects one or more of your fingers, but can also affect your toes. It's important to diagnose and treat this condition quickly because it may become serious if left untreated. We will cover the basics of what paronychia is, how it is treated, and what you can do to prevent it in the future so you can have an informed discussion with your healthcare provider about your symptoms. 

What causes paronychia?

Paronychia typically occurs as a result of infection, irritants, or allergens. The most common cause is due to bacteria infecting the skin around your nails. This condition may also be caused by fungi and yeast infections if it affects several fingernails at once. If left untreated paronychia can lead to nail deformity, loss of nails, and even infections that spread to other parts of your body.

Paronychia can be caused by both bacteria and fungi, present either separately or together. The most common type of bacteria to cause these infections are  Staphylococcus aureus and Streptococcus pyogenes, although they are not the only culprits. When paronychia becomes chronic, Candida albicans is the most common yeast to cause these fungal infections. However, when the infection is chronic, it can often be traced back to bacterial infections. These infections often happen in people who bite their nails or pick at them with their fingers, but it can also be caused by an allergic reaction to nail polish remover containing acetone or other factors. 

What are the different types of paronychia?

Before going further it is important to differentiate between the two types of paronychia: acute and chronic. Acute paronychia means that the infection is new and has come on suddenly. Chronic means that it's been going on for longer than a duration of six weeks.

The first type of paronychia is acute paronychia which manifests as swelling, redness, pain, or pus around your nail bed area or underneath your fingernail. It will often originate at the paronychium, or the side of the nail bed. Acute paronychia is most often caused by trauma, biting, picking, hangnails, and ingrown nails. Seemingly innocuous events such as dishwashing or receiving a splinter can also cause acute paronychia.

Chronic paronychia is a nail infection that has not improved after six weeks. It is caused by bacteria or fungus and can be commonly found if your hands or feet are in moist environments for a long duration, such as with dishwashing. It can often be caused by contact dermatitis, which is the inflammation or irritation of the skin. Common reasons for contracting it would be working with certain chemicals or cutting your cuticles too short leaving your nail beds open for infection although these are not the only methods of contracting chronic paronychia. 

Please consult your doctor or pharmacist should you have any further questions pertaining to the different types of paronychia. 

What are the symptoms of paronychia?

Paronychia is characterized by redness, swelling, or pain around one or more fingernails and, less commonly, toenails. Symptoms may also include, but are not limited to:

  • Redness
  • Swelling
  • Nail discoloration 
  • Pus formation under the affected nail plate 
  • Pus-filled abscesses 
  • Tenderness in surrounding skin
  • Nail loosening and separating from the nailbed

If left untreated paronychia can lead to more severe infections such as cellulitis or felon, a painful swelling that would need to be excised or drained, that can spread into the bloodstream causing a potentially fatal condition known as sepsis.

How is paronychia diagnosed?

Paronychia is diagnosed by looking at the nail and surrounding skin for redness, swelling, pain, warmth. The doctor may also take a swab of pus or fluid from around the nail to test in the lab if they suspect an infection present. If paronychia becomes severe enough where there are signs of cellulitis, which is a skin infection, then blood tests and imaging may be ordered by the doctor to diagnose paronychia.

What are the treatments for paronychia?

Treatment for paronychia may vary depending on the severity of the infection. Some treatments may be mild, such as soaking the affected area in warm water even though there is spotty evidence for this treatment, or finding the cause and stopping it, for example with biting nails. The primary goal is to treat any underlying cause, such as an injury or other illness that can lead to paronychia.

Treatment options include:

  • Keeping nails dry and clean by wearing gloves when working with your hands in wet conditions. 
  • Avoiding nail treatments or manicures that can lead to injury.
  • Avoiding smoking because it reduces blood flow, which makes paronychia worse.
  • Maintaining good overall health with a healthy diet and regular exercise. 
  • If an infection is present, topical antibiotics may be given, as well as oral medications.
  • If the cause is a fungus, antifungal nail creams are usually prescribed.
  • Topical steroids may also be prescribed to help with an infection. 

Finally, if other treatments do not work, the nail may be removed using surgery. This is not common; however, it is necessary for the most extreme circumstances. Always consult your healthcare provider about which treatment will work best for you. 

How do I prevent paronychia?

You can prevent paronychia by maintaining good nail hygiene. This means keeping nails short, washing hands regularly, and scrubbing under the fingernails to remove any bacteria that might be residing there. You should also avoid injuring your fingers or toes and keeping them dry when possible. 

If you choose to wear artificial nails, use a reputable nail technician and make sure they know your medical history. Avoid using artificial nails as much as you can. 

You should also check that any clothing or bedding is soft so it does not irritate the skin around fingernails or toenails. Paronychia is often caused by infection, so it is important to keep hands and feet clean. You should also avoid picking or tearing at your skin around the nails as this can lead to infection.

Summary

Paronychia is an infection of the skin around a fingernail or toenail and is most commonly caused by bacteria or fungus. There are two types of paronychia: acute, which lasts a short period of time, and chronic, which lasts over six weeks. The most common symptoms are redness, swelling, and tenderness around the nail for both forms of paronychia although there are a variety of other symptoms. Your doctor can usually diagnose paronychia by observing the affected areas, although sometimes other tests may be needed to determine the type of infection, whether it is bacterial or fungal. Treatments tend to be mild, with oral or topical antibiotics, and topical antifungals and steroids being the most commonly prescribed medications. To prevent paronychia, maintain good nail hygiene by cleaning your hands and nails regularly. We hope you have a better understanding of the causes, symptoms, and treatments for paronychia. Should you have any further questions please consult a medical professional regarding treatment. 

Sources: 

Cleveland Clinic – Nail Infection (Paronychia)

Harvard Health Publishing – Paronychia 

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