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Paronychia (Nail Infection)

Paronychia (Nail Infection) Overview

An infection that develops along the edge of the fingernail or toenail is called a paronychia (pear-ah-NIK-ee-ah). It is the most common hand infection and, if left untreated, can progress to a more severe infection of the entire finger or toe.

Paronychia Causes

Paronychias are most often caused by common skin bacteria entering the skin around the nail that has been damaged by trauma, such as nail biting, finger sucking, dishwashing, or chemical irritants. Fungus also can be a cause of paronychia formation, especially in people with recurrent infection.

Paronychia Symptoms

A paronychia may start as redness and swelling around the nail, called a cellulitis. It is most often very sore to the touch and, at times, may be a yellow-green color, indicating that a collection of pus has formed under the skin (called an abscess).

The most common symptoms are the following:

Swelling

Redness

Pus collection

Pain and tenderness to touch

When to Seek Medical Care

You should call your doctor if the redness extends beyond the skin around your nail or to the pad of the finger. This redness shows that the infection might be forming a more serious finger infection of the deep tissues of your fingertip, called a felon.

You should also call your doctor if an abscess is forming. An abscess requires drainage by a doctor. Opening (or incising) an abscess to drain the pus should not be attempted at home.

At the first sign of pus collection, you should seek medical attention for possible drainage. If you notice that the swelling and redness has extended down your finger or you are unable to move the joints of the affected finger, you need to go to a hospital's emergency department immediately. This condition may or may not be associated with fever or chills, indicating a serious infection.

Exams and Tests

Your doctor will examine your finger and decide how severe the infection is and what treatment is needed.

Paronychia Treatment - Self-Care at Home

Care at home includes warm soaks in a mixture of 50% warm water and 50% liquid antibacterial soap 3-4 times daily for about 15 minutes. This soaking should be done at the first sign of redness around the nail.

Medical Treatment

If an abscess (pus pocket) has formed, the recommended treatment is to drain the abscess by doing an incision and drainage procedure.

Your doctor will most likely use medicine (such as lidocaine) to numb the entire finger first and then will open the abscess using a surgical knife (scalpel).

Sometimes packing called a wick is placed in the abscess to allow it to continue to drain when you go home and to keep it from closing up and re-forming the abscess. The packing is usually left in for 24-48 hours.

In extreme cases, infection can move under the fingernail and need partial or complete nail removal. Unless there is an extensive cellulitis, antibiotics are usually not necessary.

Your doctor may or may not take a culture of the drainage to check for a bacterial infection.

After your doctor has drained the paronychia, warm soaks are still recommended. Usually, antibiotics are only prescribed if the infection involves more of the finger than around the nailbed. It is important to follow up with your doctor in 24-48 hours to be sure that the infection is healing properly.

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WebMD Medical Reference from eMedicineHealth