Nail Infection (Paronychia)

Overview

What is a nail infection (paronychia)?

Paronychia is nail inflammation that may result from trauma, irritation or infection. It can affect fingernails or toenails.

Paronychia can develop when bacteria enter broken skin near the cuticle and nail fold, causing an infection. The cuticle is the skin at the base of the nail. The nail fold is where the skin and nail come together.

Healthcare providers treat paronychia with antibiotics to kill the infection. Providers may also drain pus (thick, infectious fluid that builds up around a wound). They may also culture the fluid to see what specific bacteria might be causing the infection.

Sometimes, the infection comes back or symptoms last for weeks (chronic paronychia). Chronic paronychia is more commonly caused by irritation from occupational or environmental exposures. Less often, it may be caused by a chronic bacterial or fungal infection.

How common is paronychia?

Paronychia is a common nail condition. Anyone can get a bacterial nail infection, but it’s more common among people who:

  • Are exposed to irritants: Detergents and other chemicals can irritate the skin and lead to a nail bed infection. People who work with chemicals and don’t wear protective gloves have a higher risk.
  • Bite their nails or cuticles: Nail biting or picking at the cuticles can create tiny cracks in the nails or cuts in the skin. Bacteria may enter the skin through these small cuts.
  • Have certain skin conditions: People who have underlying skin conditions may be more likely develop nail infections.
  • Work with water: Bartenders, dishwashers and other people with jobs that require their hands to be wet have a higher risk of developing paronychia.

Symptoms and Causes

What are the symptoms of a nail infection (paronychia)?

Symptoms of paronychia usually develop over several hours or days. Sometimes they take longer to develop. Symptoms appear where the nail meets the skin (the nail fold and cuticle). The sides of the nail can also be affected.

Paronychia symptoms include:

  • Pain, swelling and tenderness around the nail.
  • Skin that is red and warm to the touch.
  • Pus that builds up under the skin. A white to yellow, pus-filled abscess may form. If an abscess forms, it may require antibiotics and/or drainage.

Untreated, the nail can start to grow abnormally and may have ridges or waves. It may look yellow or green, and it can be dry and brittle. The nail can detach from the nail bed and fall off.

What causes paronychia?

Most commonly, infectious paronychia results from a staph infection. Staphylococcus aureus bacteria cause staph infections. Other bacteria (such as Streptococcus pyogenes) can also cause the infection. Bacteria get into the skin through:

  • Cuts, broken skin or hangnails.
  • Ingrown nails (this happens most often with ingrown toenails).
  • Irritation from water or chemicals.
  • Trauma to the nailbed or cuticle area. Trauma can result from accidents, nail biting or frequent manicures or pedicures.

    Some medications can also cause paronychia. Some of these medications include retinoids, anti-cancer medications, HIV medications and some antibiotics.

What are the types of paronychia?

There are two types of paronychia. Both types have similar signs and symptoms:

  • Acute paronychia: Symptoms of acute paronychia appear over hours or a few days. The infection is only in the nail fold and doesn’t extend deeper inside the finger or toe. Symptoms go away with treatment and last less than six weeks.
  • Chronic paronychia: Symptoms develop more slowly than acute paronychia, and they usually last six weeks or longer. Several fingers or toes can be infected at once. A nail fungus (usually from a type of fungus called candida) may occur along with the bacterial infection. Candida is one of several types of fungi that cause toenail fungal infections.

Diagnosis and Tests

How is paronychia diagnosed?

Your provider will ask about your symptoms and do a physical exam. Healthcare providers usually don’t need to order tests to diagnose a nail infection. Occasionally, providers may take a sample of the tissue and send it to a lab to test for specific infectious causes such as bacteria or fungi. Rarely, if the infection is severe, imaging (such as an X-ray) may be ordered to check for involvement of the underlying bone.

Management and Treatment

Can I treat paronychia at home?

You may be able to treat mild cases of paronychia at home. Soak the infected area in warm water for about 15 minutes a few times a day. Be sure to dry the area thoroughly. Soaking the cuticle and nailbed helps pus drain from under the skin.

If symptoms don’t get better after a day or two of home remedies, see your provider. You may need other treatments, such as antibiotics, to clear up the infection and help you heal. You may also need minor procedures such as drainage if an abscess has formed.

What is the treatment for nail infections (paronychia)?

Most bacterial nail infections go away with antibiotics. These medications kill bacteria that cause infections. Be sure to follow your provider’s instructions and finish the entire course of antibiotics so the infection doesn’t return.

If pus has built up around the nail bed and isn’t draining on its own, your provider may drain the pus. After cleaning the area, your provider makes a small cut so the pus can drain. Your provider places a bandage over the cut. You should keep the area clean and replace the bandage when necessary.

Prevention

Can I prevent nail infections (paronychia)?

To prevent a nail infection, you should:

  • Avoid biting or chewing on your nails or hangnails. Don’t pick at your cuticles.
  • Be careful not to cut your nails too short. When trimming cuticles, avoid cutting too close to the nail fold.
  • Maintain good hygiene by washing your hands and keeping your nails clean. Use gentle soaps that are not irritating to your skin.
  • Use lotion on your nail fold and cuticles if your skin is dry. Excessive dryness can cause the skin to crack.
  • Wear waterproof gloves if you work with chemicals or your hands will be wet for a long period.

Outlook / Prognosis

What is the outlook for people with paronychia?

Paronychia usually clears up with treatment. Some people get more than one infection, or the infection comes back after treatment (chronic paronychia). Untreated, the infection can cause damage to the nail.

Rarely, untreated paronychia can go deeper into the finger or toe and lead to a serious infection. The infection may progress to involve the underlying bone. In severe cases, providers need to remove a finger or toe to make sure the infection doesn’t spread to the rest of the body. Severe, chronic paronychia most often affects people who have diabetes or conditions that cause problems with blood circulation.

Living With

When should I see my healthcare provider about paronychia?

If you have diabetes or another condition that affects your circulation, or are immunosuppressed, call your provider as soon as you notice signs of infection. You should seek immediate care if you have a condition that affects your body’s ability to fight infection.

See your provider if symptoms are severe or don’t go away after a few days. If symptoms return after treatment, call your provider for an evaluation.

A note from Cleveland Clinic

Nail infections can be painful, but they don’t usually cause serious health problems. If your job requires you to work with chemicals or detergents, or if your hands are frequently wet, talk to your provider. You can protect your hands and avoid an infection by wearing waterproof gloves that do not irritate the skin. Seek treatment right away if you have diabetes or difficulty fighting infections. Also, see your provider if paronychia comes back after treatment, or if your symptoms worsen or don’t go away.

Last reviewed by a Cleveland Clinic medical professional on 08/16/2021.

References

  • Dulski A, Edwards CW. Paronychia. (https://www.ncbi.nlm.nih.gov/books/NBK544307/) [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 9/17/2021.
  • Haneke E. Chapter 91: Nail disorders. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, Orringer JS, eds. Fitzpatrick's Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019. Accessed 9/17/2021.
  • Merck Manuals. Acute Paronychia. (https://www.merckmanuals.com/home/skin-disorders/nail-disorders/acute-paronychia) Accessed 9/17/2021.
  • Stevens DL, Bisno AL, Chambers HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. (https://academic.oup.com/cid/article/59/2/e10/2895845) Clinical Infectious Diseases. 2014;59(2):e10-52. Accessed 9/17/2021.

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