Paronychia (Nail Infection)

What Is Paronychia?

Paronychia (pahr-uh-NIK-ee-uh) is an infection of the skin around a fingernail or toenail. The infected area can become swollen, red, and painful, and a pus-filled blister (abscess) may form.

Most of the time, paronychia is not serious and can be treated at home. In rare cases, the infection can spread to the rest of the finger or toe and lead to a deeper infection that may need a doctor's help.

Kids usually don't get paronychia in a toe (unless they have an ingrown toenail). But fingernail paronychia is one of the most common hand infections.

What Causes Paronychia?

Paronychia usually happens when the skin around the nail is irritated or injured. When skin gets damaged like this, germs can get in and cause an infection. These germs can be:

• bacteria, causing bacterial paronychia
• fungi, causing fungal paronychia

Injuries that may lead to finger or toe infection include:

• biting or pulling off a hangnail
• frequent sucking on a finger
• clipping a nail too short or trimming the cuticle
• getting manicures
• having hands in water a lot (as from a job washing dishes)
• having an ingrown toenail

Kids with diabetes also have a higher chance of getting paronychia infections.

What Are the Signs & Symptoms of Paronychia?

If your child has paronychia, it's usually easy to recognize. Look for:

• an area of red, swollen skin around a nail that's painful, warm, and tender to the touch
• a pus-filled blister

Bacterial paronychia usually appears very suddenly. Fungal paronychia can take longer to notice and causes less obvious symptoms, and it can be a chronic condition (last for a long time).

Chronic paronychia can cause changes in the affected nail. It might turn a different color or look as though it is detached or abnormally shaped.

In rare cases, if the paronychia is especially severe and goes untreated, the infection can spread beyond the area of the nail.

How Is Paronychia Diagnosed?

Usually, a health care provider can diagnose paronychia by looking at the infected area. In some cases, they may take a pus sample to be checked in a laboratory to see what type of bacteria or fungus caused the infection.

How Is Paronychia Treated?

Treating paronychia depends on how severe the infection is and whether it has started to spread. Often, soaking the infected nail in warm water for 20 minutes a few times a day will help it heal on its own in a few days. An over-the-counter topical anti-bacterial ointment may be recommended too.

If there's an abscess, a doctor might need to drain it. In rare cases, part of the nail may have to be removed. The doctor also might prescribe antibiotics to treat the infection.

Usually, after an abscess is drained, the affected finger or toe heals quickly with no long-term problems.

For fungal paronychia, the doctor may prescribe antifungal creams, lotions, or oral (taken by mouth) medicines.

Can Paronychia Be Prevented?

Have kids follow these tips to lower their risk of paronychia:

• Don't bite or pick nails.
• Trim fingernails and toenails with clippers or manicure scissors, and smooth the edges with an emery board or nail file. The best time to do this is after a bath or shower, when nails are softer. They shouldn't cut their nails too short.
• Don't push cuticles back or trim them and don't use cuticle remover. Damaging cuticles can let bacteria get into the skin and cause an infection.
• Wear rubber gloves if there's a chance their hands might be in contact with harsh detergents or chemicals.
• If your child has diabetes, make sure it is well-controlled.

As much as possible, have kids try to avoid injuring their nails and the skin around them. Nails grow very slowly, so any damage to them can last a long time and increase the risk of paronychia.

When Should I Call the Doctor?

Call your doctor if:

• Your child has paronychia that doesn't get better with treatment.
• The infection seems to be spreading.