Paronychia

Paronychia is common. It is from injury to the area, such as biting off or picking a hangnail or from trimming or pushing back the cuticle.

The infection is caused by:

• Bacteria
• Candida, a type of yeast
• Other types of fungi

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

Fungal paronychia may occur in people who:

• Have a fungal nail infection
• Have diabetes
• Expose their hands to water a lot

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 cause the condition to come on 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.

If the infection spreads to the rest of the body, symptoms may include:

• Fever, chills
• Development of red streaks along the skin
• General ill feeling
• Joint pain
• Muscle pain

Your health care provider 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.

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

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

If you have chronic fungal paronychia, your provider may prescribe antifungal medicine.

Paronychia often responds well to treatment. But, fungal infections may last for several months.

Complications are rare, but may include:

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

Call your provider if:

• Paronychia symptoms continue despite treatment
• Symptoms worsen or new symptoms develop

To prevent paronychia:

• Care for your nails and the skin around your nails properly.
• Avoid damaging your nails or fingertips. Because the nails grow slowly, an injury can last for months.
• Do not bite or pick your nails.
• Protect your nails from exposure to detergents and chemicals by using rubber or plastic gloves. Gloves with cotton liners are best.
• Bring your own manicure tools to nail salons. Do not allow the manicurist to work on your cuticles.

To minimize the risk for damage to your nails:

• Keep fingernails smooth and trim them weekly.
• Trim 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 do not cut them too short.
• Do not trim cuticles or use cuticle removers. Cuticle removers can damage the skin around the nail. The cuticle is needed to seal the space between the nail and skin. Trimming the cuticle weakens this seal, which can allow germs to enter the skin and lead to infection.

Infection - skin around the nail

Andre J, Sass U, Theunis A. Diseases of the nails. In: Calonje E, Brenn T, Lazar AJ, Billings SD, eds. McKee's Pathology of the Skin. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 23.

Dinulos JGH. Nail diseases. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 25.

Leggit JC. Acute and chronic paronychia. Am Fam Physician. 2017;96(1):44-51. PMID: 28671378 pubmed.ncbi.nlm.nih.gov/28671378/.

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.

Updated by: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.