Nail infection (paronychia) is a nail disease that develops along the edge of a person’s finger or toe nail (on the sides or base) where the skin and nail meet. The infection, caused by bacteria or fungus, may develop suddenly or over a period of time. This common infection can progress into a severe infection of the finger or toe, if it is not treated.
Types of Paronychia
Acute paronychia occurs in the tissues surrounding a fingernail or, less commonly, a toenail, and lasts for less than 6 weeks. There will be local redness, inflammation and pain. It is caused by direct/indirect trauma to the nail fold or cuticle from minor events like dishwashing, nail biting, sucking finger, manicuring, and picking at hand nail or a splinter or thorn injury. Pus may or may not be present.
If the infection lasts for more than 6 weeks, it is considered to be chronic paronychia. This nail disease is common in people whose hands/feet remain moist and is frequently due to contact dermatitis. The cuticle gets separated from the nail plate. This causes the space between the nail plate and proximal nail fold to get infected. Chronic paronychia occurs often due to washing dishes, sucking finger, aggressive trimming of the cuticles or prolonged contact with mild acids, alkalis, etc.
Paronychia may also be classified as candidal paronychia (nail fold inflammation caused by candida albicans) or pyogenic paronychia (nail fold inflammation caused by bacteria). Typically, acute paronychia is pyogenic paronychia as it is often caused by bacteria.
Paronychia is different form herpetic whitlow which also leads to the formation of tiny pustules. Herpetic whitlow is a viral infection and it does not usually occur at the nail-skin edge.
Signs and Symptoms of Paronychia
The infection may start as inflammation and redness in the area surrounding the nail the nail. Often, there will be a sore feeling when touched and sometimes it may have a yellow-green color. This is indicative of the formation of an abscess or collection of pus under the skin. The most commonly seen signs and symptoms are swelling, redness, collection of pus, tenderness to touch and pain.
Medical attention should be sought if the redness tends to extend beyond the skin-nail edge or to the finger pad. This is because it indicates that the infection is more serious with formation of pus in the deep tissues. A visit to the doctor is also essential, if an abscess has formed or the redness and swelling has extended down the finger and it is difficult to move the finger joints or there is fever and chills. The abscess has to be drained by a doctor. It should never be done at home.
Treatment of Paronychia
If there is no pus formation, then warm soaks may be sufficient.
If there is abscess formation, then the recommended treatment is drainage of the pus through an incision by a doctor. Sometimes a packing, referred to as wick, is provided for about 24 to 48 hours in order to ensure continuous draining and reformation of the abscess.
If the infection is serious and has moved under the nail, it may call for partial/complete nail removal. Generally, antibiotics are prescribed only if the infection has spread to the distal part of the limb. After draining the pus, the doctor may provide warm soaks to ensure that it heals properly. If the doctor determines that antibiotics may be required, then he/she will prescribe clindamycin or cephalexin.
A topical cream/lotion and a topical steroid are often prescribed for treating chronic paronychia. If the condition does not improve, the doctor may prescribe oral antifungals and steroids. Sometimes, the nail fold is surgically removed in order to alleviate the infection.
Herbal remedies and topical applications that use the best of traditional and herbal medicine, such as funginix, to treat mild to medium-high nail infections are also available.
Prevention of Paronychia
As always, prevention is better than cure. The best option is to exercise caution against risk factors such as repeated washing of hands, trauma to the cuticle because of biting or other events, diabetes, drug-induced immunosuppression, systemic diseases like pemphigus, etc.
Those whose job involve frequent hand washing or exposure to moisture, it is important that they wear rubber gloves when working. If the job involves handling dirt or the chances of cuts and scrapes are high, then they should wash the hands and feet thoroughly after work and keep them dry afterwards.