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Paronychia

Definition

Paronychia is a skin infection that occurs around the nails.

Alternative Names

Infection - skin around the nail

Causes, incidence, and risk factors

Paronychia is fairly common. It is usually caused by injury to the area -- for example, from biting off or picking a hangnail or from trimming or pushing back the cuticle.

• Bacterial paronychia is caused by bacteria.
• Candidal paronychia is caused by a specific type of yeast.
• Fungal paronychia is caused by a fungus other than Candida.

A bacterial and fungal infection may occur at the same time.

Fungal paronychia may be seen in persons with a fungal nail infection. It is also common among persons with diabetes and those who have their hands in water for long periods of time.

Symptoms

The main symptom is a painful, red, swollen area around the nail, often at the cuticle or at the site of a hangnail or other injury. There may be pus-filled blisters, especially with a bacterial infection.

Bacteria causes the condition to occur suddenly. If all or part of the infection is due to a fungus, it tends to occur more slowly.

Nail changes may occur. For example, the nail may look detached, abnormally shaped, or have an unusual color.

Signs and tests

The doctor can usually diagnose this condition by simply looking at the sore skin.

Pus or fluid may be drained and sent to a laboratory to determine what type of bacteria or fungus is causing the infection.

Treatment

If you have bacterial paronychia, soaking your nail in hot water 2 or 3 times a day helps reduce swelling and pain.

Your doctor may prescribe antibiotics. In severe cases, your doctor may cut and drain the sore with a sharp instrument. Part of the nail may need to be removed.

If you have fungal paronychia, your doctor may prescribe antifungal medicine. Keep your hands dry and apply a skin-drying substance, such as Castellani's paint.

Support Groups

Expectations (prognosis)

Paronychia usually responds well to treatment. However, fungal infections may last for several months.

Complications

Complications are rare, but may include:

• Abscess
• Permanent changes in the shape of the nail
• Spread of infection to tendons, bones, or bloodstream

Calling your health care provider

Call your health care provider if:

• Paronychia symptoms continue despite treatment
• Symptoms worsen or new symptoms develop, such as:
  • Chills
  • Development of red streaks along the skin
  • Fever
  • General ill feeling
  • Joint pain
  • Local spread of symptoms
  • Muscle pain

Prevention

To prevent paronychia:

• Care for the nails and the skin around the nails properly.
• Avoid damaging the nails or fingertips. Because the nails grow slowly, an injury can last for months.
• Do not bite or pick the nails.
• Protect the nails from exposure to detergents and chemicals by using protective rubber or plastic gloves, preferably with cotton liners.

To minimize the risk of damage to the nails:

• Keep the nails smooth and trim them weekly.
• Trim the toenails about once a month.
• Use sharp manicure scissors or clippers for trimming fingernails and toenails, and an emery board for smoothing the edges.
• Trim nails after bathing, when they are softer.
• Trim fingernails with a slightly rounded edge. Trim toenails straight across and don't cut them too short.
• Do not trim cuticles or use cuticle removers. Cuticle removers may damage the skin around the nail. Trimming the cuticle damages the skin at the base of the nail and allows an entry point for fungi (and bacteria), which can lead to infection.

References

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004.