Paronychia - Causes, Treatment, and Ways to Prevent

What Is Paronychia?

It is inflammation of fingernails or toenails that may result from trauma, irritation, or infection. Paronychia can develop when bacteria invade broken skin (through cuts, cracks, or abrasion) near the cuticle and nail fold area, causing an inflammatory condition resulting in infection.

Who Is More Prone to Paronychia?

Paronychia is a nail condition commonly caused by bacterial infection. It is very common among individuals who are:

Exposure to Common Skin Irritants: Skin irritants like detergents and chemicals cause inflammation of the skin when protective covering or gloves are not used and result in a nail bed infection.

Biting the Nails or Cuticles: Biting the nails or picking at the cuticles causes tiny cuts, cracks, or abrasions in the nail or wound. These small cuts and cracks facilitate the bacterial invasion of the skin that leads to nail bed infection.

Skin Conditions: People with underlying skin conditions such as eczema or dry skin are more likely to develop nail infections.

Occupational Hazards: Cleaners, bartenders, dishwashers, and other people in occupations that demand constant work that requires their hands to be wet are at an increased risk of developing paronychia.

What Causes Paronychia?

Most commonly, Staphylococcus aureus bacteria cause Staph infections that result in paronychia. It is also known that other bacteria, such as Streptococcus pyogenes and Candida yeast, can also cause the infection. Bacteria get into the skin through the following:

​​Cuts, cracks, broken skin near the nail bed, cuticles, or hangnails.

Ingrown nails in the fingers or toes.

Irritation to the skin near the nail bed from water, detergents, or chemicals.

Injury or trauma to the nailbed or cuticle area. Trauma can result from accidents, nail biting, picking at the nail bed, or frequent manicures or pedicures.

Certain medications like Retinoids, anti-cancer medications, and HIV medications can also cause paronychia.

What Are the Symptoms of Paronychia?

The symptoms of paronychia are:

Pain, swelling, and tenderness around the nail.

Skin that is inflamed.

Redness of the skin around the nails.

Tenderness of the skin around the nail.

Pus under the skin.

Abscess formation (a white to yellow, pus-filled blister).

Changes in the shape, color, or texture of the nail.

What Are the Types of Paronychia?

Based on the speed of onset, the duration, and the infecting agent, paronychia can be classified into two types:

Acute Paronychia: Acute paronychia is a sudden onset (symptoms appear over hours or a few days) of infection that occurs around the fingernails and develops quickly. Fingers and toes are not affected by the infection since it is limited to the nail fold. Acute paronychia is caused by damage to the skin around the nails and nail bed region due to biting, picking, hangnails, manicures, or other physical trauma or injury. Staphylococcus and Enterococcus bacteria are the most common infecting pathogens that cause acute paronychia. This condition lasts for less than six weeks and resolves well with treatment.

Chronic Paronychia: Chronic paronychia has a slow onset and develops more slowly than acute paronychia. The symptoms usually last six weeks or longer. Chronic paronychia infects several fingers or toes at once. This is most commonly caused by a nail fungus called Candida, along with a bacterial infection. It is more common in people who are constantly working in water. Chronic paronychia may require medical supervision.

How Is Paronychia Diagnosed?

Assessing symptoms and physical examination can help diagnose paronychia. Occasionally, the healthcare provider will take a tissue sample and send it to a lab to be tested for specific infectious pathogenic causes like bacteria or fungi. In severe cases, an imaging study (such as an X-ray) is ordered to check for the involvement of the underlying bone.

How Does Paronychia Affect the Body’s Systems?

Paronychia occurs when the protective covering between the nail and the cuticle, known as the nail fold, is damaged.

Predisposing variables for trauma, infections (such as bacterial, viral, and fungal), structural abnormalities, and inflammatory illnesses (such as psoriasis) include manicures and pedicures. Organisms will infiltrate the damp gap in the nail, resulting in colonization of the region.

Most cases of acute paronychias are caused by trauma, nail-biting, excessive manicuring, and artificial nails and may include a foreign object that has been left behind. Staphylococcus aureus is the primary cause of infections.

Streptococci and Pseudomonas are frequently encountered in cases of persistent infections. Uncommon causal agents include gram-negative bacteria, dermatophytes, herpes simplex virus, and yeast. Children are susceptible to acute infection because they frequently bite their nails and suck their fingers, which allows oral bacteria to enter their bodies. These bacteria can be both aerobic and anaerobic.

How Is Paronychia Treated?

Mild cases of paronychia can be treated at home successfully. If there is pus under the skin, soak the infected area in warm water for 15 minutes several times a day and thoroughly dry it afterward. The soaking will cause the pus under the skin to drain naturally.

If the symptoms are not resolved by the simple intervention done at home, it is necessary to seek medical supervision. The doctor will prescribe antibiotics that help the bacteria and clear up the infection to heal well.

Severe cases of nail infection may require pus or abscess drainage to prevent the spread of infection and promote healing. In such cases, the doctor collects the pus and sends it to a laboratory to check for causative pathogens.

Can Paronychia Be Prevented or Avoided?

The best measure to prevent nail infection or paronychia is to take good care of the nails.

Caring for the nails includes:

Avoid injury or physical trauma to the nails and fingertips.

Avoid biting, chewing, or picking the nails.

Keep the nails clean, trimmed, and smooth.

Avoid cutting nails too short.

Be cautious while scraping or trimming the cuticles, as this can injure the skin.

Use a clean nail clipper.

Be careful while getting a manicure and pedicure.

Wear gloves or waterproof protective coverings while working with chemicals and detergents, undergoing prolonged exposure, or soaking in water.

Moisturize the nail beds and cuticles in case of dry skin.

How Can One Treat the Condition at Home?

If one has mild to severe acute paronychia, one can try soaking the afflicted toe or finger in warm water multiple times a day. If their symptoms do not improve, they should consult a medical expert for additional treatment.

All needed to treat mild paronychia is salt and lemon.

Patients can get rid of the illness by slicing a lemon, filling it with salt, and then submerging the afflicted finger in the lemon for a few minutes. They suggest doing this again until the infection clears up. That being said, there is no scientific proof that this can treat paronychia.

Applying a paste made of magnesium sulfate to the affected area is another DIY treatment. People say that this can prevent infection and aid in pain control. Nevertheless, there does not seem to be any scientific proof for this assertion either.

Treatment for chronic paronychia may last for several weeks or months. It is critical to have clean, dry hands the entire time. A person might need to take time off if their line of work involves handling pathogens or getting their hands wet.

People who believe they have paronychia or another form of toe or toenail infection should get medical advice from a physician, as many at-home cures lack scientific backing.

When to Consult a Health Care Provider for Paronychia?

It is essential to seek the healthcare provider’s consultation and advice when paronychia does not resolve or subside after doing home care remedies like soaking the fingers or toes in warm water several times a day. If symptoms like redness, warmth to touch, pus, tenderness, and pain persist, it is important to see the doctor for further evaluation. If having diabetes or any other medical conditions that affect circulation or are immunosuppressed, it is critical to seek immediate medical attention to prevent the infection from spreading and worsening.

Conclusion:

Paronychia is an infection of the skin surrounding a toenail or fingernail, which results in pain, redness, warmth, tenderness, and pus in the nail bed area. It is most commonly caused by bacteria and Candida yeast. The treatment of paronychia is simple for mild cases, and severe cases may need antibiotic coverage and imaging study. Paronychia usually responds well to treatment.