Overview of paronychia
Paronychia is an infection of the skin around your nails and feet. Usually, bacteria or a type of yeast called Candida causes this infection. Bacteria and yeast can combine into a single infection.
Depending on the cause of the infection, paronychia may come on slowly and last for weeks, or appear suddenly and last for only a day or two. The symptoms of paronychia are easy to spot and can be treated easily and successfully with little or no harm to your skin and nails. The infection can become severe and may lead to partial or complete loss of your nails if left untreated.
Types of Paronychia
Acute and chronic paronychia
Paronychia can be acute or chronic depending on the speed of onset, duration, and the factors causing the infection.
An acute infection always occurs around the nails and develops rapidly. It is usually the result of damage to the skin around the nails from biting, picking, hanging nails, manicures, or any other physical trauma. Staphylococcus and enteric bacteria are common infectious agents in acute paronychia.
Chronic paronychia can occur on your fingers or toes, and it develops slowly. It lasts for several weeks and often returns. It usually results from more than one infecting agent, most often Candida yeast and bacteria. It is more common among people who work constantly in the water. Chronic wet skin and excessive soaking disrupt the skin’s natural barrier. This allows yeast and bacteria to grow and enter under the skin to create an infection.
What are the symptoms of paronychia?
It usually begins with pain, swelling, and redness around the base or sides of the nail. Acute paronychia can cause pus-filled pockets (abscesses) to form.
Chronic paronychia may cause breakouts. This type of paronychia may eventually cause the nail to separate from the skin. The nail may become thick, hard, and misshapen. It caused by bacteria can get worse quickly. It caused by a fungus that usually gets worse slowly over time.
What causes paronychia?
It occurs when the skin surrounding a nail is irritated or injured. Germs enter the skin and cause infection. These germs can be bacteria or fungi. The skin is often injured by biting, chewing, or pulling nails. It can also be caused by pulling nails or sucking fingers. An ingrown toenail can also cause this disease.
Moisture allows certain germs, such as candida (a type of fungus) and bacteria, to thrive. People whose hands may be wet for long periods are more likely to have chronic paronychia. This may include bartenders, dishwashers, food handlers, or home cleaners. Chronic paronychia may also be caused by irritant dermatitis, a condition that causes the skin to be red and itchy. Once the skin is irritated, germs can take hold and cause infection.
It is more common in adult women and people with diabetes. People with weakened immune systems are also more likely to have this disease. This includes people who must take medication after an organ transplant or people who have HIV.
Treatments for this disease vary depending on its severity and whether it is chronic or acute. A person with moderate to severe paronychia can try soaking the affected finger or toe in warm water three to four times a day. If symptoms do not improve, seek further treatment.
When a bacterial infection causes severe paronychia, your doctor may recommend an antibiotic, such as dicloxacillin or clindamycin. When a fungal infection causes chronic paronychia, a doctor will prescribe an anti-fungal medication. These are topical medications and usually include clotrimazole or ketoconazole.
Chronic paronychia may require weeks or months of treatment. It is important to keep hands dry and clean at all times. If a person’s job requires their hands to be wet or exposed to germs, they may need to take time off.
The doctor may also need to drain any pus from surrounding cysts. To do this, they will administer a local anaesthetic, then open the fold of the nail just enough for the gauze to be inserted, which helps drain the pus.
Acute paronychia can spread and cause a serious infection in the hand (cellulitis) and may involve the underlying tendons (infectious tendinitis).
The main complication of chronic paronychia is nail atrophy. It is often associated with deformed and warped nail plates. It may become yellow or green/black and brittle. After healing, it takes up to a year for the nails to return to normal.
It is a clinical diagnosis and is often supported by laboratory evidence of infection.
- Gram stain microscopy may reveal bacteria
- Microscopic examination of potassium hydroxide may reveal fungi
- Bacterial culture
- Viral smears
- Tzank smears
- Nail clippings for culture (mycology).
Taking proper care of your nails will greatly reduce the chance of developing an infection. Don’t chew your nails or stick to the skin around them. Do not trim the skin at the base of the nail. Disrupting the nail or the skin will cause bacteria and fungi to enter. In general, you should keep your hands away from chronic exposure to water and avoid any irritants or allergens from coming into contact with your skin.