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Paronychia

Infection of the skin fold around a nail, causing a painful swelling

  • Repeated immersion of the hands in water is a risk factor
  • Age, gender, and genetics are not significant factors

Infection of the fold of skin surrounding a fingernail or toenail (nail fold) is called paronychia. The infection causes pain and swelling, which may develop either suddenly (acute paronychia) or gradually over several months (chronic paronychia), depending on the underlying cause. One or more nails may be affected by the condition.

What are the causes?

Acute paronychia is usually the result of a bacterial infection entering the nail fold through a cut or break in the skin. Chronic paronychia is common among people such as cooks who repeatedly immerse their hands in water. The skin around the nail separates from the nail, softens, and becomes infected, usually by a yeast organism. A secondary bacterial infection may then occur, resulting in acute paronychia. Some people with decreased resistance to infection, such as those with diabetes mellitus, are at increased risk of paronychia.

What are the symptoms?

Usually, the symptoms of acute paronychia become apparent about 24 hours after infection and include:

  • Pain and swelling on one side of the nail fold.

  • Build-up of pus around the nail.

If acute paronychia is left untreated, the nail may separate from the nail bed and eventually fall away. The symptoms of chronic paronychia develop over several months. The condition may cause some discomfort and swelling but does not usually produce a build-up of pus. Eventually, the affected nail thickens slightly and develops horizontal ridges and brownish discoloration.

What is the treatment?

Your doctor may prescribe oral antibiotics for acute paronychia. In severe cases, pus may be drained under local anaesthesia. Chronic paronychia may be treated with an over-the-counter cream containing an antifungal drug, but if there is a secondary infection your doctor may prescribe stronger antifungals and oral antibiotics. Acute paronychia often clears up in a few days with treatment. Chronic paronychia may take several weeks.

To prevent chronic paronychia, you should dry your hands thoroughly after washing and wear cotton-lined rubber gloves when your hands are in water.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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