Paronychia: How Is It Caused And How Would You Treat It?

Paronychia: How Is It Caused And How Would You Treat It?

Nail inflammation, or paronychia, can be brought on by injury, irritation, or infection. It generally only impacts toenails or fingernails.1

The lateral or proximal creases of the toenail and fingernail can become infected spontaneously or as a result of trauma or manipulation. Since it is one of the most prevalent hand infections, it is critical to understand how to treat it properly.2

People with paronychia will notice that the folds of the tissue that surround their toe or fingernail are inflamed. There are two types of paronychia: acute and chronic. The former refers to an infection that lasts less than six weeks, and the latter persists for more than six weeks.3

Trauma to the cuticle or nail fold, direct or indirect, is the key factor contributing to the development of paronychia. This makes it possible for microorganisms to infect the nail and cause an infection.4

Who is most likely to contract paronychia?

Paronychia is one of the most common nail conditions a person can get. However, those who belong to any of the following groups are much more susceptible to it1:

  • People who are more exposed to irritants:Chemicals such as detergents and others can result in skin irritation and cause an infection of the nail bed. A more significant risk exists for those who handle chemicals without wearing protective gloves.
  • People who have the habit of biting their nails: Tiny skin wounds or nail fissures can result from biting your nails or picking at your cuticles. These tiny incisions could allow bacteria to penetrate the skin and cause an infection.
  • People with skin conditions:Nail infections may be more common in people with underlying skin conditions.
  • People who work with water:Paronychia is also more likely to occur in those who work in vocations that necessitate wet hands, such as bartenders, dishwashers, and others.

Diagnosis

There’s no laboratory test or imaging that will help to diagnose a case of paronychia. Hence, the doctor will need a solid history and physical showing a swollen and sensitive nail fold. The infection is typically simple to treat, but the development of an abscess may not always be obvious.2

Symptoms of paronychia 

Paronychia symptoms typically appear over the course of many hours or days. Sometimes, they can take longer to form. The symptoms of this condition are most likely to manifest where the nail reaches the skin (the cuticle and nail fold). The nail’s sides may also be impacted.

Said symptoms include:

  • Ache, swelling, and soreness surrounding the nail
  • Reddish, warm-to-the-touch skin
  • Pus that accumulates beneath the skin. An abscess filled with pus, ranging from white to yellow, could develop. If an abscess develops, medications and/or drainage may be necessary.

If left untreated, the nail may begin to grow irregularly and develop ridges or waves, seeming yellow or green and brittle and dry. The nail could even separate from the nail bed and fully come off.1

Treatment options

Fortunately, paronychia is largely treatable. Here are the recommended treatments for those with the condition:

Acute paronychia

For individuals with paronychia of the acute variety, warm water compresses and soaking the injured digit in Burow’s solution (aluminium acetate), or vinegar may be helpful – as long as an abscess hasn’t formed. For symptomatic relief, non-steroidal anti-inflammatory or acetaminophen medicine should be taken into consideration. Topical antibiotics – that may or may not consist of corticosteroids, oral antibiotics, or a surgical incision, as well as drainage, are all possible treatments for acute paronychia.4

Chronic paronychia

Patients with chronic paronychia should minimise contact irritants, and it is advised to treat any pre-existing inflammation and swelling with an amalgamation of a corticosteroid and a broad-spectrum topical anti-fungal medication. Emollient lotion application could also be advantageous. Systemic anti-fungals are less effective than topical steroid creams at treating persistent paronychia. En bloc removal of the proximal nail fold is an alternative for chronic paronychia resistant to treatment. Another option is to do an eponychial marsupialisation, which may result in nail removal.4

Conclusion

Although they can be uncomfortable, nail infections seldom result in significant health issues. Speak with your employer if your line of work needs you to handle detergents or chemicals or if your vocation requires your hands to be wet constantly. Using good-quality waterproof gloves will protect your hands and prevent illness. If you have diabetes or trouble battling infections, get help immediately away. Additionally, consult your healthcare physician if paronychia returns during treatment or if the symptoms worsen or persist.

You can also visit Angeline Yong Dermatology, a dermatology clinic in Singapore that is well-equipped to deal with various skin, hair, and nail conditions – including paronychia. Contact us today to learn more.

References

Paronychia (nail infection): What is it, symptoms, causes and treatment. Cleveland Clinic. (2021, August 16). Retrieved December 12, 2022, from https://my.clevelandclinic.org/health/diseases/15327-nail-infection-paronychia

Dulski, A., & Edwards, C. W. (2022). Paronychia. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK544307/

Relhan, V., & Bansal, A. (2022). Acute and Chronic Paronychia Revisited: A Narrative Review. Journal of cutaneous and aesthetic surgery15(1), 1–16. https://doi.org/10.4103/JCAS.JCAS_30_21

Rigopoulos, D., Larios, G., & GREGORIOU, S. (2008). Acute and Chronic Paronychia. American Family Physician. https://doi.org/2008;77(3):339-346