Best treatments for paronychia

Identifying and Treating Different Types of Paronychia

There are two main types of paronychia: acute and chronic. Acute paronychia comes on suddenly and is usually from a bacterial infection, often after an injury to the nail or cuticle. The most common bacteria are Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas. 8 Symptoms include:

• rapid onset of pain
• redness
• swelling
• pus around the affected nail

Soaking your nails in warm water several times a day can help relieve discomfort and speed up healing. For more severe cases, topical or oral antibiotics may be needed, along with draining any pus that has collected. 8,10

Chronic paronychia, on the other hand, develops over time and typically is caused by a fungal infection (Candida albicans) or irritation from frequent exposure to water, soaps, or chemicals. 8 It may cause:

• persistent redness
• swelling
• changes to the nail itself, such as thickening or discoloration
• cuticle pulling away from the nail 8

Treatment typically uses antifungal creams or pills, along with steroid creams to calm inflammation.1,9 Identifying and avoiding triggers is also important.

Some less common types of paronychia include herpetic whitlow, caused by the herpes simplex virus, and paronychia related to certain medications, like chemotherapy drugs or antiretrovirals. 5,6 These cases may need specialized treatment approaches. In some cases, paronychia can lead to more serious infections if left untreated. It may spread deeper into the finger or toe and affect the tendon underneath. 7

People with diabetes or weakened immune systems are more prone to acute paronychia. 4 Severe or recurrent chronic paronychia that doesn't improve with other treatments may need surgery. 2,3

Home Remedies and Self-Care for Paronychia

If you think you have paronychia, there are some things you can do at home to help relieve symptoms and promote healing. Soaking the affected finger or toe in warm water for 15-20 minutes, 3-4 times per day, can reduce pain and swelling. 14,18 You can also apply an over-the-counter antibiotic ointment after soaking. 20

It's important to keep the skin around your nails dry and to avoid further irritation. Wear gloves when washing dishes or working with harsh chemicals. Resist the urge to pick at the area.

While home care can be helpful for mild cases, it's not always enough. If symptoms last more than a couple days or worsen (increased pain, pus, fever, etc.), you should see a healthcare provider. 12,22

When To Seek Medical Attention for Paronychia

Most cases of paronychia can be managed at home, but sometimes medical treatment is necessary. If you experience these symptoms, see a healthcare provider:

• severe pain
• substantial swelling
• visible pus
• high fever or other signs of a systemic infection, such as chills, fatigue, or generally feeling unwell
• spreading redness or red streaking up the finger or toe 12,22,27,28

These could be signs of a more serious infection that requires prompt treatment.

Certain people are at higher risk for complications from paronychia and should see a healthcare provider sooner. This includes people with diabetes, a weakened immune system, or peripheral arterial disease. 13,33 If left untreated with these conditions, paronychia can more easily spread to deeper tissues like tendons, joints, or bones. 32

Your healthcare provider will examine the affected area and possibly take a sample of any pus or fluid to identify what is causing the infection. Treatment may include prescription oral or topical antibiotics, antifungal medications, or steroids depending on the cause. In some cases, the provider may need to drain pus or remove damaged tissue. 27,28

Chronic paronychia is more difficult to treat and often needs the help of a healthcare provider. 27,28 Your provider may prescribe antifungal medication and tell you to keep the area dry. 27,28

In severe cases of chronic paronychia, you may need surgery. 35,36 Procedures like eponychial marsupialization or the Swiss roll technique can help remove the chronically inflamed tissue and allow medications to work better. 2,3,25,26 Surgery is usually only considered after other treatments have failed. 35,36

Preventing Paronychia and Nail Infections

While paronychia is common, the good news is that it's also preventable in many cases. Practicing good nail hygiene is important. Here are some things you can do to help prevent paronychia:

• Keep your nails trimmed short
• Avoid biting your nails or picking at your cuticles
• Wear protective gloves when working with water or chemicals
• Minimize exposure to potential irritants
• Wash your hands thoroughly after any exposure
• If your hands are frequently immersed in water throughout the day, take regular breaks to dry them completely
• Clean and cover any injuries to the nail or surrounding skin
• Dry your hands and feet thoroughly after exposure to moisture
• Change socks and shoes regularly to prevent fungal growth 14,21,24

People with diabetes should be especially vigilant about foot care, as nerve damage and poor circulation can make it harder to feel problems like ingrown toenails or sores that could develop into paronychia. 13,24

Artificial nails and frequent manicures can also increase the risk of paronychia by breaking the protective seal between the nail and the skin. 24 If you do choose to get manicures, make sure the salon follows proper hygiene practices and avoid pushing back or cutting your cuticles. 24

Understanding the Risk Factors of Paronychia

The most common bacteria that cause paronychia are Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas. In chronic paronychia, which tends to be less painful and less responsive to antibiotics, the fungus Candida albicans is often the cause. 37

Certain factors make some people more prone to developing paronychia, such as:

• diabetes
• any condition or medication that weakens your immune system, such as HIV or chemotherapy
• psoriasis
• dermatitis
• frequent swimming in chlorinated pools
• occupations that keep your hands continually wet, like dishwashing or bartending 4,29,30,31,38,39,40

By being aware of these risk factors, you can take steps to reduce them. This might mean using a moisturizing hand cream if you wash your hands a lot, being extra cautious about nail care if you have diabetes, or talking to your healthcare provider about managing underlying health issues. 38

Conclusion

Paronychia may be a common condition, but it's important not to ignore it. Catching and treating it early can prevent what starts as a minor annoyance from turning into a major problem.

Whether your paronychia is acute or chronic, caused by bacteria or fungus, there are treatment options available. For many people, simple home care like warm soaks and antibiotic ointment will do the trick. More stubborn or severe cases may need prescription medications or in-office procedures.

If you do develop signs of paronychia, don't hesitate to see a healthcare provider if it's not improving with home care or is accompanied by severe symptoms. With proper treatment and prevention strategies, you can keep your nails healthy and paronychia-free.

Citations:

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<2>Bednar, M. S., & Lane, L. B. (1991). Eponychial marsupialization and nail removal for surgical treatment of chronic paronychia. The Journal of Hand Surgery, 16(2), 314-317.</2>

<3>Pabari, A., Iyer, S., & Khoo, C. T. (2011). Swiss roll technique for treatment of paronychia. Techniques in Hand & Upper Extremity Surgery, 15(2), 75-77.</3>

<4>Kapellen, T. M., Galler, A., & Kiess, W. (2003). Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes mellitus than in non-diabetic peers. Journal of Pediatric Endocrinology and Metabolism, 16(5), 751-758.</4>

<5>Colson, A. E., Sax, P. E., Keller, M. J., Turk, B. K., Pettus, P. T., & Platt, R. (2003). Paronychia in association with indinavir treatment.</5>

<6>Saito, Y., Uchiyama, K., Takekuma, Y., Komatsu, Y., & Sugawara, M. (2023). Risk factor analysis for anti-epidermal growth factor receptor monoclonal antibody-induced skin toxicities in real-world metastatic colorectal cancer treatment. Investigational New Drugs, 41(2), 375-383.</6>

<7>Gaurav, V., Tyagi, M., Grover, C., & Das, S. (2022). Ungual Scabies: A Case Report and Review of Literature. Indian Journal of Dermatology, 67(1), 102.</7>

<8>Rigopoulos, D., Larios, G., Gregoriou, S., & Alevizos, A. (2008). Acute and chronic paronychia. American Family Physician, 77(3), 339-346.</8>

<9>Tosti, A., Piraccini, B. M., & Ghetti, E. (2002). Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. Journal of the American Academy of Dermatology, 47(1), 73-76.</9>

<10>Shaw, J., & Body, R. (2005). Best evidence topic report. Incision and drainage preferable to oral antibiotics in acute paronychial nail infection?. Emergency Medicine Journal, 22(11), 813-814.</10>

<11>Paronychia: Causes and treatment of an infected nail (2022). Retrieved from https://www.medicalnewstoday.com/articles/324059</11>

<12>How to Treat Paronychia at Home (and Prevent it in the First Place) (2022). Retrieved from https://www.byrdie.com/how-to-treat-paronychia-at-home-6560816</12>

<13>Paronychia (Nail Infection): What Is It, Symptoms, Causes and Treatment (2022). Retrieved from https://my.clevelandclinic.org/health/diseases/15327-nail-infection-paronychia</13>

<14>Treating Paronychia at Home: Self-Care, Causes, & More (2022). Retrieved from https://www.wikihow.com/Treat-Paronychia</14>

<15>Paronychia - Skin Infection Around the Nails | familydoctor.org (2022). Retrieved from https://familydoctor.org/condition/paronychia/</15>

<16>Paronychia (Nail Infection) Treatment: First Aid Information for Paronychia (Nail Infection) (2022). Retrieved from https://www.webmd.com/first-aid/paronychia-nail-infection-treatment</16>

<17>Paronychia: Causes, Symptoms, and Diagnosis (2022). Retrieved from https://www.healthline.com/health/paronychia</17>

<18>Harvard Medical School. (2022). Treating Paronychia at Home: Self-Care, Causes, & More. Retrieved from https://www.wikihow.com/Treat-Paronychia</18>

<19>Medical News Today. (2022). Paronychia: Causes and treatment of an infected nail. Retrieved from https://www.medicalnewstoday.com/articles/324059</19>

<20>Cleveland Clinic. (2022). Paronychia (Nail Infection): What Is It, Symptoms, Causes and Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/15327-nail-infection-paronychia</20>

<21>Byrdie. (2022). How to Treat Paronychia at Home (and Prevent it in the First Place). Retrieved from https://www.byrdie.com/how-to-treat-paronychia-at-home-6560816</21>

<22>WebMD. (2022). Paronychia (Nail Infection) Treatment: First Aid Information for Paronychia (Nail Infection). Retrieved from https://www.webmd.com/first-aid/paronychia-nail-infection-treatment</22>

<23>Healthline. (2022). Paronychia: Causes, Symptoms, and Diagnosis. Retrieved from https://www.healthline.com/health/paronychia</23>

<24>Mallett RB, Banfield CC, Goon PKC. Paronychia. In: Lebwohl MG, Heymann WR, Coulson IH, Murrell DF, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 182.</24>

<25>Bednar MS, Lane LB. Eponychial marsupialization and nail removal for surgical treatment of chronic paronychia. J Hand Surg Am 1991;16:314–17. PubMed Central.</25>

<26>Pabari A, Iyer S, Khoo CT. Swiss roll technique for treatment of paronychia. Tech Hand Surg 2011;15:75–7. PubMed.</26>

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<28>Rockwell PG. Acute and chronic paronychia. Am Fam Physician. 2001 Mar 15. 63(6):1113-6. [QxMD MEDLINE Link].</28>

<29>Chronic paronychia is more commonly caused by irritation from occupational or environmental exposures. Less often, it may be caused by a chronic bacterial or fungal infection. ... Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.</29>

<30>Yoshitaka, Y., Kazuki, U., Yoh, T., Yoshito, K., & Mitsuru, S. (2022). Risk factor analysis for anti-epidermal growth factor receptor monoclonal antibody-induced skin toxicities in real-world metastatic colorectal cancer treatment. Supportive Care in Cancer, 30(5), 4193-4201.</30>

<31>Tanda, M., Yamamoto, K., Hori, T., Nishiguchi, H., Yagi, M., Shimizu, M., ... & Yano, I. (2022). Association of STAT3 -1697C>G polymorphism with osimertinib-induced paronychia in patients with non-small cell lung cancer. Cancer Chemotherapy and Pharmacology, 89(4), 487-495.</31>

<32>Wong, Y. C., Chen, H. C., & Lai, C. C. (2021). Extensive pyomyositis secondary to paronychia-related MRSA infection: A case report. Journal of the Formosan Medical Association, 120(1), 677-680.</32>

<33>Al-Bayati, A., Alshami, A., AlAzzawi, M., Al Hillan, A., & Hossain, M. (2022). Metastatic Osteoarticular Infective Endocarditis by Methicillin-sensitive Staphylococcus Aureus. Cureus, 14(3).</33>

<34>Dhandha, M. M. (2022). Skin Infections and Outpatient Burn Management: Skin Infections in Patients With Diabetes. Clinics in Podiatric Medicine and Surgery, 39(1), 1-16.</34>

<35>Liu, T. H., Wu, S. Y., Tsai, S. L., Wu, C. W., Hou, C. C., Lai, C. Y., & Tzeng, Y. S. (2022). Effective and enduring surgical treatment for targeted therapy-related paronychia: A retrospective study. Medicine, 101(42), e31208.</35>

<36>Pierrart, J., Delgrande, D., Mamane, W., Tordjman, D., & Masmejean, E. H. (2016). Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients. Hand Surgery and Rehabilitation, 35(1), 40-43.</36>

<37>Acute paronychia is usually caused by bacterial infections, most often with Staphylococcus aureus. However, other bacteria like Streptococcus pyogenes and Pseudomonas, as well as the cold sore virus and the yeast Candida albicans, can also cause acute paronychia. This type of paronychia comes on quickly, causing pain, redness, and swelling around a single nail.</37>

<38>Certain occupations and medical conditions put people at higher risk for developing chronic paronychia. Those who work with their hands in water a lot, like dishwashers, bartenders, and housekeepers, are more prone to the condition. People with diabetes, HIV/AIDS, or other conditions that weaken the immune system are also at increased risk. Some medications, including retinoids, chemotherapy drugs, and certain antibiotics, can also contribute to chronic paronychia.</38>

<39>No matter the cause, paronychia results from a breakdown in the protective barrier between the nail and the skin around it. This allows germs to get in and cause an infection. Factors that can disrupt this barrier include minor injuries, structural abnormalities, and inflammatory skin conditions like psoriasis.</39>

<40>Paronychia results from the disruption of the protective barrier between the nail and the nail fold, which is the cuticle. Trauma (including manicures and pedicures), infections (including bacterial, viral, and fungal), structural abnormalities, and inflammatory diseases (ex. psoriasis) are predisposing factors.</40>

<41>Trauma (including manicures and pedicures), infections (including bacterial, viral, and fungal), structural abnormalities, and inflammatory diseases (ex. psoriasis) are predisposing factors. Organisms will enter the moist nail crevice, which leads to colonization of the area. The majority of acute paronychias are due to trauma, nail-biting, aggressive manicuring, artificial nails, and may involve a retained foreign body.</41>

<42>The eponychium (also called the cuticle), an outgrowth of the proximal nail fold, forms a watertight barrier between the nail plate and the skin, protecting the underlying skin from pathogens and irritants.2 · Acute paronychia is the result of a disruption of the protective barrier of the nail folds.</42>

<43>The eponychium (also called the cuticle), an outgrowth of the proximal nail fold, forms a watertight barrier between the nail plate and the skin, protecting the underlying skin from pathogens and irritants.2 · Acute paronychia is the result of a disruption of the protective barrier of the nail folds (Acute and Chronic Paronychia | AAFP, 2017).</43>