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Paronychia

Paronychia is a skin infection that occurs around the nails.

Alternative Names

Infection - skin around the nail

Causes

Paronychia is common. It is often caused by injury to the area -- such as, from biting off or picking a hangnail or from trimming or pushing back the cuticle.

Paronychia may be caused by:

  • Bacteria
  • Candida (yeast), a type of fungus 
  • Other types of fungi

A bacterial and fungal infection can occur at the same time.

Fungal paronychia may occur in persons who have:

Symptoms

Main symptom is a painful, red, swollen area around the nail, often at the cuticle or at the site of a hangnail or other injury. There may be pus-filled blisters , especially with a bacterial infection.

Bacteria causes the condition to come on suddenly. If all or part of the infection is due to a fungus, it tends to occur more slowly.

Nail changes may occur. For example, the nail may look detached, abnormally shaped, or have an unusual color.

Exams and Tests

The doctor can usually diagnose this condition by simply looking at the sore skin.

Pus or fluid may be drained and sent to a laboratory to determine what type of bacteria or fungus is causing the infection.

Treatment

If you have bacterial paronychia, soaking your nail in hot water 2 or 3 times a day helps reduce swelling and pain.

Your doctor may prescribe oral antibiotics. In severe cases, your doctor may cut and drain the sore with a sharp instrument. Part of the nail may need to be removed.

If you have fungal paronychia, your doctor may prescribe antifungal medicine. Keep your hands dry and apply a skin-drying substance, such as Castellani paint (phenol).

Outlook (Prognosis)

Paronychia usually responds well to treatment. However, fungal infections may last for several months.

Possible Complications

Complications are rare, but may include:

  • Permanent changes in the shape of the nail
  • Spread of infection to tendons, bones, or bloodstream

When to Contact a Medical Professional

Call your health care provider if:

  • Paronychia symptoms continue despite treatment
  • Symptoms worsen or new symptoms develop, such as:
    • Chills
    • Development of red streaks along the skin
    • Fever
    • General ill feeling
    • Joint pain
    • Local spread of symptoms
    • Muscle pain

Prevention

To prevent paronychia:

  • Care for the nails and the skin around the nails properly.
  • Avoid damaging the nails or fingertips. Because the nails grow slowly, an injury can last for months.
  • Do not bite or pick the nails.
  • Protect the nails from exposure to detergents and chemicals by using rubber or plastic gloves. Gloves with cotton liners are best.
  • Bring your own manicure tools to nail salons.

To minimize the risk of damage to the nails:

  • Keep the nails smooth and trim them weekly.
  • Trim the toenails about once a month.
  • Use sharp manicure scissors or clippers for trimming fingernails and toenails, and an emery board for smoothing the edges.
  • Trim nails after bathing, when they are softer.
  • Trim fingernails with a slightly rounded edge. Trim toenails straight across and do not cut them too short.
  • Do not trim cuticles or use cuticle removers. Cuticle removers can damage the skin around the nail. Trimming the cuticle damages the skin at the base of the nail. This can allow germs to enter, which can lead to infection.

References

Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2009:chap 25.

Tosti A, Piraccini BA. Nail disorders. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 71.

Updated: 5/15/2013

Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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