Drexel University College of Medicine

Diseases and Conditions

Paronychia

Definition

Paronychia is a skin infection that occurs around the nails.

Alternative Names

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 inflammation and pain.

Your doctor may prescribe antibiotics. In severe cases, your doctor may cut and drain the lesion 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 hands dry and apply a skin-drying substance, such as Castellani's paint.

Expectations (prognosis)

Paronychia usually responds well to treatment, although fungal infections may last for several months. Complications are rare.

Complications

Complications are rare, but may include:

• Abscess
• Spread of infection to tendons, bones, or bloodstream

Calling your health care provider

Call your health care provider if paronychia symptoms persist despite treatment.

Call your health care provider if symptoms worsen or new symptoms develop:

• Localized spread of symptoms
• Development of red streaks along the skin
• Fever
• Chills
• General ill feeling
• Joint pain
• Muscle pain

Prevention

To prevent paronychia, care for the nails and the skin around the nails properly. Avoid damage to the nails or the fingertips. Do not bite, or pick the nails. Because the nails grow slowly, damage can cause an injury that lasts for months. 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 them smooth and trim them weekly. Because the toenails grow more slowly, trim them about once a month. For fingernails and toenails, use sharp manicure scissors or clippers for trimming and an emery board for smoothing the edges. The nails may be softer and easier to trim after bathing. 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 are corrosive and may damage the skin around the nail. Trimming the cuticle results in damage to the skin at the base of the nail and allows an entry point for fungi (and bacteria), which can result in infection.

References

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

Physician Reference

International Classification of Diseases, 9^th Revision (ICD9)

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