Paronychia is an infection or inflammation of the periungual tissue, which surrounds the fingernails or toenails. It is one of the most common infections affecting the hand and is often caused by bacterial, fungal, or mixed pathogens. Paronychia can be acute or chronic and may lead to significant pain, swelling, and functional limitations if not properly managed.
Types of Paronychia: Acute vs. Chronic
Acute Paronychia
Acute paronychia develops rapidly and is typically caused by a bacterial infection. Common pathogens include Staphylococcus aureus, Streptococcus species, and occasionally anaerobic bacteria. It often follows minor trauma, nail biting, hangnails, or manicuring.
Key Characteristics:
- Sudden onset of pain and swelling around the nail fold
- Redness and warmth in the affected area
- Possible pus formation and abscess development
Chronic Paronychia
Chronic paronychia is defined as inflammation persisting for more than six weeks. It is frequently caused by fungal organisms such as Candida albicans, often in combination with bacterial pathogens.
Key Characteristics:
- Slow onset with intermittent symptoms
- Affected nail folds appear swollen, red, and retracted
- Nail dystrophy, ridging, and discoloration may develop
- Common in individuals with prolonged exposure to moisture (e.g., dishwashers, bartenders)
Pathophysiology and Causes of Paronychia
Common Etiologies
| Type of Agent | Specific Causes |
|---|---|
| Bacterial | Staphylococcus aureus, Streptococcus pyogenes |
| Fungal | Candida albicans, dermatophytes |
| Mechanical Trauma | Nail biting, aggressive manicuring, acrylic nails |
| Chemical Irritants | Detergents, water, cleaning agents |
| Underlying Conditions | Diabetes mellitus, immunosuppression, eczema |
Clinical Symptoms and Signs of Paronychia
Acute Paronychia Symptoms
- Throbbing pain around the nail fold
- Swelling and redness localized to one side of the nail
- Warmth and tenderness
- Accumulation of pus under the cuticle or nail fold
Chronic Paronychia Symptoms
- Persistent inflammation and swelling of the nail fold
- Thickened or discolored nail plate
- Intermittent pain or discomfort
- Nail detachment in severe cases (onycholysis)
Diagnosis of Paronychia: Clinical and Laboratory Approaches
Diagnosis is primarily clinical, based on physical examination of the nail and surrounding tissue. Additional tests may be warranted for complicated or recurrent cases.
Diagnostic Tools
- Culture and Sensitivity Testing: For bacterial and fungal identification in recurrent or non-responsive infections
- KOH Preparation: To detect fungal elements
- Ultrasound Imaging: To assess abscess formation or differentiate from felon (deep fingertip infection)
Paronychia Treatment: Medical and Surgical Options
Management of Acute Paronychia
Conservative Treatment
- Warm Soaks: 3–4 times daily to promote drainage and relieve discomfort
- Topical Antibiotics: Mupirocin or fusidic acid for mild cases
- Oral Antibiotics: Cephalexin or clindamycin for moderate to severe infections
Surgical Intervention
- Incision and Drainage: Required for abscess formation
- Partial Nail Plate Removal: In severe or recurrent cases to access deep infection
Management of Chronic Paronychia
- Elimination of Moisture Exposure: Protective gloves, minimizing water contact
- Topical Antifungals: Clotrimazole or ketoconazole applied daily
- Topical Steroids: Low-potency corticosteroids to reduce inflammation
- Oral Antifungals: Itraconazole for persistent or severe fungal infections
Paronychia in Special Populations
In Children
Often related to thumb-sucking or nail biting. Conservative treatment is typically effective unless there is an abscess.
In Diabetics and Immunocompromised Patients
Increased risk of rapid progression and complications. Prompt and aggressive treatment is essential.
Complications of Untreated or Recurrent Paronychia
- Abscess formation requiring surgical drainage
- Permanent nail deformities
- Spread of infection to deeper tissues (cellulitis or osteomyelitis)
- Felon (deep pulp space infection of the fingertip)
- Onycholysis (detachment of the nail from the nail bed)
Preventive Measures to Avoid Paronychia
- Avoid nail biting and aggressive manicuring
- Keep hands dry and avoid prolonged exposure to water
- Use moisturizing creams and protective gloves
- Avoid sharing nail tools
- Practice good hand hygiene
- Treat underlying skin conditions (e.g., eczema, psoriasis)
Frequently Asked Questions:
What is the fastest way to treat paronychia?
Warm soaks and topical antibiotics are the first-line treatment. If pus is present, drainage may be necessary.
Can chronic paronychia be cured?
Yes, with strict avoidance of irritants, consistent antifungal treatment, and improved hand hygiene, chronic paronychia can be resolved.
Is paronychia contagious?
The infection itself is not usually contagious, but poor hygiene can increase the spread of pathogens.
When should I see a doctor for paronychia?
If swelling, pain, and redness persist for more than a few days or if there is visible pus, medical evaluation is advised.
Can paronychia recur?
Yes, especially if contributing factors such as moisture exposure, trauma, or underlying fungal infection are not addressed.
Paronychia, whether acute or chronic, requires prompt recognition and targeted treatment to prevent complications and ensure optimal nail health. Proper hygiene, moisture control, and early intervention are key to managing and preventing this common nail condition. As awareness grows and care improves, outcomes continue to advance for individuals affected by this often underestimated yet highly treatable condition.
