Table of ContentsView AllTable of ContentsCausesSymptomsDiagnosisTreatmentPreventionComplicationsWhen to Seek Care
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Diagnosis
Treatment
Prevention
Complications
When to Seek Care
Topical antibioticsmay be needed to clear the bacteria infection. If a nail fungus is involved, atopical antifungalmay be prescribed. While most cases are mild and will resolve on their own, some can turn severe and lead to complications likecellulitis.
This article looks at the causes and symptoms of paronychia, including what it looks like and how it is diagnosed and treated. It also describes ways to prevent nail infections and when to see a healthcare provider.
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Types of Nail Infections
Paronychia is the inflammation of the nail folds, namely the lateral nail folds on either side of the nail and the proximal nail fold adjacent to the cuticle (the layer of skin at the base of the nail). The nail plate and nail bed can also be collaterally damaged.
Paronychia can beacute(sudden and severe) orchronic(persistent or recurrent). Acute cases almost invariably involve bacteria, while chronic cases are typically associated with fungi or chemical irritants.
By definition, acute infections are those that last less than six weeks, while chronic infections are those that persist or recur for more than six weeks.
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNet and © Raimo Suhonen dermnetnz.org 2023
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from © DermNet and © Raimo Suhonen dermnetnz.org 2023
Bacterial Nail Infections
Paronychia is primarily bacterial in origin. WhileStaphylococcus aureusis the main culprit, other bacteria likePseudomonas aeruginosaandStreptococcus pyogenes(the cause ofstrep throat) can also cause acute paronychia.
Bacteria can penetrate nail folds in different ways:
Staphylococcus aureusis a common cause because it is naturally found in high concentrations in the nose as well as on the skin.Streptococcus pyogenesis also found in the nose, mouth, and skin,whilePseudomonas aeruginosais commonly found in soil and water.
The Risk of Nail Salon Infections
Fungal Nail Infections
Chronic paronychia is commonly associated with fungal nail infections (known alternately as onychomycosis andtinea unguium).
With onychomycosis, the infection can sometimes spread and colonize the nail folds. Because the infection is notoriously difficult to treat, the swelling can persist and become chronic.
While common fungi likeTrichophyton rubrum(associated withathlete’s foot) can sometimes cause paronychia,it is most often seen withCandida albicans, the fungus associated withyeast infectionsandoral thrush.
As withStaphylococcus aureus, Candida albicansis found naturally in the human body. But unlikeStaphylococcus aureus,it most often causes disease when a weakened immune system allows the fungus to grow out of control.
As a result, paronychia associated withCandida albicansmainly affects:
Noninfectious Causes of Paronychia
Bacterial and Fungal Infections of the Toes and Feet
What Does a Nail Infection Look Like?
Paronychia is easily recognized and something that most people will experience at one time or another. It mainly affects the nail folds but can also affect the nail bed and nail plate.
Common symptoms include:
Left untreated, the nail can develop ridges, waves, and yellowish or greenish discoloration. The nail can become dry and brittle and crack or entirely detach from the nail bed. Fingernails are affected more than toenails.
Although it can be difficult to tell if the condition is bacterial or fungal, there are several clues:
BacterialTends to last less than six weekDevelops rapidly over two to five days, causing significant pain and swelling in all three nail foldsMay only affect one fingernail or toenail as the infection is localizedMore commonly involves abscessesAssociated with nail trauma or injuryFungalTends to persist or recur for more than six monthsDevelops slowly, usually starting at the proximal nail fold before spreading to the lateral nail foldsUsually affects multiple fingers or toes as the underlying cause is often systemic (affecting the whole body)Abscesses are uncommonAssociated with immune suppression or occupational water exposure
BacterialTends to last less than six weekDevelops rapidly over two to five days, causing significant pain and swelling in all three nail foldsMay only affect one fingernail or toenail as the infection is localizedMore commonly involves abscessesAssociated with nail trauma or injury
Tends to last less than six week
Develops rapidly over two to five days, causing significant pain and swelling in all three nail folds
May only affect one fingernail or toenail as the infection is localized
More commonly involves abscesses
Associated with nail trauma or injury
FungalTends to persist or recur for more than six monthsDevelops slowly, usually starting at the proximal nail fold before spreading to the lateral nail foldsUsually affects multiple fingers or toes as the underlying cause is often systemic (affecting the whole body)Abscesses are uncommonAssociated with immune suppression or occupational water exposure
Tends to persist or recur for more than six months
Develops slowly, usually starting at the proximal nail fold before spreading to the lateral nail folds
Usually affects multiple fingers or toes as the underlying cause is often systemic (affecting the whole body)
Abscesses are uncommon
Associated with immune suppression or occupational water exposure
Occupational paronychia is more commonly associated withCandida albicansbut can sometimes involve the bacteriaPseudomonas aeruginosawhich thrives in water.
This Super Common Nail Infection Often Goes Untreated
How Is a Nail Infection (Paronychia) Diagnosed?
As part of the physical exam, the provider may perform a digital pressure test in which you are asked to press your thumb and affected finger together. If there is an abscess, the skin overlying the abscess will blanch (whiten).
Pus extracted from an abscess may beculturedto identify the exact bacteria or fungi, but this is usually not helpful. Only around 4% of these cultures can identify a single causal agent; most detect multiple bacterial types.
If your signs or symptoms are atypical, your healthcare provider may order tests to exclude other possible causes as part of thedifferential diagnosis,including:
Nail Infection (Paronychia) Treatment
Acute paronychia is bacterial in origin and typically treated with home remedies, topical antibiotics, or abscess drainage. Chronic paronychia is treated differently based on its severity and underlying cause.
Home Remedies
Acute paronychia doesn’t always require medical treatment. If there is some pus, soaking your finger or toe for 10 to 15 minutes, several times a day can help drain the pus and speed healing.
Some experts recommend addingEpsom saltto the soaking solution, particularly for conditions like ingrown nails,Others endorse the use of vinegar or an over-the-counter (OTC) astringent called Burow’s solution, both of which have been used for generations to treat skin infections.
If using apple cider or distilled white vinegar, add 1 tablespoon to 6 cups of water to make a 1% vinegar solution.
Over-the-Counter Drugs
Topical antibiotics are commonly used to treat paronychia.Three over-the-counter (OTC) options may help:
All three exert activity againstStreptococcus aureusandStreptococcus pyogenes.Polysporin may be especially useful as it also contains a skin-numbing agent calledlidocaine.
Prescription Medications
Prescription antibiotics may be prescribed if home and OTC remedies fail to provide relief.
Topical antibiotics are preferred over oral antibiotics, which have not proven more effective in treating uncomplicated paronychia. If anything, oral antibiotics are associated with a greater risk ofantibiotic resistance.
Topical antibiotics your healthcare provider may prescribe include:
Fluoroquinolones are especially effective againstPseudomonas aeruginosa.Atopical steroidlike Diprolene (betamethasone 0.05% cream) may also be prescribed to help ease inflammation.
Oral antibiotics are reserved for severe cases that don’t respond to topical treatment or for people who are severely immunocompromised.
Oral options include:
Abscess Drainage
In the event of an abscess,medical treatmentmay be needed to drain the accumulated pus. Drainage should not be done at home as it can lead to a severe infection if not done correctly or with sterile equipment.
Topical lidocaine can be used to help numb the skin, but this is generally not needed.
Once the pus is drained, oral antibiotics are not needed. Instead, you can soak the wound two to three times daily for several days with diluted Burow’s solution or a 1% vinegar solution. This is generally all that is needed to promote healing and prevent infection.
Treating Chronic Paronychia
Natural Remedies for Fungal Nail Infections
How to Prevent Nail Infections (Paronychia)
To reduce the risk of paronychia:
What’s the Outlook for People With Paronychia?
With appropriate treatment, most cases of acute paronychia will quickly resolve without complications. Although chronic paronychia can take weeks to heal, the nail and surrounding skin usually return to normal.
However, if paronychia is not appropriately treated, it can lead to discoloration, ridges, cracks, and the total loss of your nail. Even if the nail does return, it may not ever fully return to normal (referred to as chronicnail dystrophy).
Certain people may develop severe complications if the infection happens to spread. People who are immunocompromised are most commonly affected, including those withadvanced untreated diabetes.
Rare complications of paronychia include:
When to Contact a Healthcare Provider
As a general rule, you should see a healthcare provider if symptoms of paronychia do not improve with conservative treatment or if you suspect that you have an abscess.
Seek immediate care if there are signs that the infection spreading, including:
Summary
Paronychia is an infection of the skin surrounding the nail, called nail folds. Bacteria cause acute infections, while chronic infections are most frequently associated with fungus. Symptoms include redness, pain, warmth, and redness. Left untreated, paronychia can an abscess, nail deformity, and nail loss.
Paronychia is diagnosed with a physical exam. Acute cases may be treated with warm soaks and topical antibiotics. Chronic cases may require topical steroids, antifungals, or tacrolimus. Abscesses should be a healthcare provider to drain the accumulated pus safely.
Causes of a Loose Fingernail or Toenail You May Not Know
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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