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Paronychia

Definition

Paronychia is a skin infection that occurs around the nails.

Alternative Names

Infection - skin around the nail

Causes

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:

Symptoms

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

Exams and Tests

The 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.

Treatment

If you have bacterial 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.

Outlook (Prognosis)

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

Possible Complications

Complications are rare, but may include:

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

When to Contact a Medical Professional

Call your provider if:

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

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 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 the 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.

Gallery

Paronychia - candidial
Candida paronychia produced periungual erythema, edema and nail fold maceration.
Nail infection - candidal
A paronychia is an infection around the nail. Many organisms can cause a paronychia. This particular case is caused by the yeast-like organism Candida. Note the inflammation (red, swollen area) at the base of the nail and the changes that are apparent in the nail itself.

References

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. Paronychia. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson IH, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 182.

Last reviewed April 14, 2021 by Elika Hoss, MD, Senior Associate Consultant, Mayo Clinic, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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