Definition

Paronychia is an infection that affects the folds adjacent to the nail and the perionychium (which consists of nail folds and a nearby nail bed). In other words, paronychia is an infection of the soft tissue surrounding the nail or the cuticle and usually affects either the vertical or horizontal part of the nail. Paronychia may occur because of injury, irritation, or infection of the nail. This condition may affect the fingernails or toenails. Paronychia can occur in any age group, including adults and children. It is not a serious disorder and it usually improves with treatment.

In general, there are two types of paronychia and both types of paronychia have similar signs and symptoms, namely:

• Acute paronychia is a condition where the symptoms appear within a few hours or a few days. The infection only occurs in the nail folds and does not extend deeper to the fingers or toes. Symptoms usually resolve with treatment and last less than six weeks. Acute paronychia is often caused by an infection.
• Chronic paronychia is a condition where the symptoms develop more slowly than acute paronychia and usually last for six weeks or longer. Several fingers or toes may become infected at once. Irritation is the primary cause of chronic paronychia.

Causes

There are several causes of acute and chronic paronychia. The underlying cause of each case is generally bacteria, Candida, or a combination of both. Some bacteria that often cause paronychia include Staphylococcus aureus and Streptococcus pyogenes. Some medications can also cause paronychia, including retinoids, anticancer drugs, HIV medications, and some types of antibiotics.

• Acute paronychia

Generally, acute paronychia is caused by bacterial infections that infiltrate the area surrounding the nail through an action or injury. This can be caused by a variety of activities, including biting or gouging your nails, being injured by manicure tools, excessively pressing your cuticles, and cuts or damaged skin. Furthermore, ingrown toenails have the potential to induce bacterial infections.

• Chronic paronychia

Candida fungus is the most common cause of infections in chronic paronychia; however, bacterial pathogens can also contribute to this condition. Because the fungus prefers to grow in moist areas, frequent contact with water on your palms or feet is one of the causes. Recurrent contact with water or chemicals may result in the development of nail irritation.

Risk Factors

Acute paronychia can affect anyone. The risk, however, increases in the presence of skin injury, particularly between the nail fold or cuticle and the nail plate, as in the following instances:

• Nails that are frequently bitten or nail folds that are frequently pulled out
• In neonates who engage in frequent finger or thumb sucking
• After a manicure procedure
• Ingrown toenails
• Usage of artificial or sculptured nails
• Treatment with oral retinoid medications that cause skin dryness, including Acitretin and Isotretinoin
• Usage of inhibitors of epidermal growth factor receptors and BRAF, including vemurafenib and dabrafenib

The risk of chronic paronychia is especially increased in people with a history of dermatitis (eczema) on their hands, exposure to repeated irritation (from the use of detergents or other chemicals) to hands, or hands that are constantly cold and wet, which can be found in:

• Dairy farmers
• Fishermen
• Bartenders
• Cleaners
• Housewives
• People with poor blood circulation

Acute and chronic paronychia tend to be more common in people with diabetes or other chronic diseases, or in those who have compromised immune systems due to the use of certain medications or diseases.

Symptoms

The symptoms of acute and chronic paronychia are very similar, these diseases are mostly distinguishable from each other by the speed of onset and duration of infection. Symptoms of chronic infections could come slowly and last for weeks, whereas acute infections develop quickly and the symptoms do not last long. Symptoms usually appear in nail folds and cuticles. The sides of the nail can also be affected. Symptoms of paronychia are:

• Pain, swelling, and tenderness around the nail.
• Reddish skin around the nails and becomes warm when it’s touched.
• Accumulation of pus under the skin. Abscess with white to yellow pus discharges may form in paronychia.
• If left untreated, the nails may start to grow abnormally and may have bumps or ridges. The nails may look yellow or green and may be dry or brittle. The nails may also detach from the nail bed.

Diagnosis

In diagnosing paronychia, your doctor will start by conducting an interview with you. He or she will ask you about your symptoms, the onset of symptoms, and any risk factors that may contribute to paronychia. 

Next, the doctor will perform a physical examination. They will inspect the nail condition and the area around the affected nail. They could also press the nail to assess its tenderness and examine the texture of the nail surface. 

Basically, the diagnosis of paronychia can be established from examining the medical interview and physical examination without the need for additional diagnostic tests. However, sometimes physicians may take tissue samples and send them to the laboratory to look for specific causes of infection, such as bacteria or fungi. In very rare cases, if the infection is severe, the doctor may suggest imaging studies (such as X-rays) to check if there is underlying bone involvement.

Management

The management of paronychia may vary according to the severity and type of paronychia (whether it is acute or chronic). Home care and medical treatment may help, depending on the diagnosis and severity of the condition.

Home remedies

Patients with mild acute paronychia could try soaking the affected fingers or toes in warm water several times a day. If symptoms do not improve, further treatments may be required.

Chronic paronychia may require treatments for weeks or months. It is very important to keep your hands or feet dry and clean. If your job requires your hands to be wet or makes your hands exposed to germs, then it may be necessary to take a short break from work.

Medical treatments

When a bacterial infection causes acute paronychia, the doctor may recommend the use of antibiotics, such as dicloxacillin or clindamycin. If a fungal infection causes chronic paronychia, the doctor will prescribe antifungal medication. The antifungal products prescribed are usually clotrimazole or ketoconazole ointments.

If an abscess forms on the nail, the doctor may also need to drain the pus from the surrounding abscess. To do this, they would perform an incision and drain the abscess. The doctor will administer a local anesthetic, then open the nail fold enough to insert a gauze pad to help drain the pus.

Complications

Most cases of paronychia will respond well to treatment. However, sometimes complications can still occur. In some rare cases, paronychia can cause permanent damage to your nails. If you have diabetes, there is a risk that infection can spread to deeper tissues and bones, or to the bloodstream and other parts of the body. In very severe cases of infection, paronychia can lead to the loss of fingers or toes.

Prevention

Some steps you can take to prevent paronychia include:

• Avoid biting or chewing your nails and do not pick at your nail cuticles.
• Be careful not to cut your nails too short. When cutting the cuticles, avoid cutting too close to the nail fold.
• Maintain hygiene by washing your hands and keeping your nails clean. Use a mild soap that does not irritate your skin.
• Use lotion on the nail folds and cuticles if your skin is dry. Excessive dryness can lead to chapped skin.
• Use waterproof gloves if you work with chemicals or if your hands will be wet for a long time.

When to See a Doctor?

If your symptoms are mild, you can try home treatments. However, if home treatment has not reduced your symptoms or your symptoms worsen, consult a doctor immediately.

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