Paronychia

Paronychia is an inflammatory reaction involving the folds of the skin surrounding the fingernail. This is commonly caused by an infection in the skin around a nail. The most common cause of paronychia is frequent wetting of the hands (as seen with bartenders, food servers, nurses or others who wet their hands). This makes the skin around the fingernail susceptible to infection by bacteria (germs) or fungus. Other predisposing factors are:

  • Aggressive manicuring.

  • Nail biting.

  • Thumb sucking.

The most common cause is a staphylococcal (a type of germ) infection, or a fungal (Candida) infection. When caused by a germ, it usually comes on suddenly with redness, swelling, pus and is often painful. It may get under the nail and form an abscess (collection of pus), or form an abscess around the nail. If the nail itself is infected with a fungus, the treatment is usually prolonged and may require oral medicine for up to one year. Your caregiver will determine the length of time treatment is required. The paronychia caused by bacteria (germs) may largely be avoided by not pulling on hangnails or picking at cuticles. When the infection occurs at the tips of the finger it is called felon. When the cause of paronychia is from the herpes simplex virus (HSV) it is called herpetic whitlow.

TREATMENT

When an abscess is present treatment is often incision and drainage. This means that the abscess must be cut open so the pus can get out. When this is done, the following home care instructions should be followed.

HOME CARE INSTRUCTIONS

  • It is important to keep the affected fingers very dry. Rubber or plastic gloves over cotton gloves should be used whenever the hand must be placed in water.

  • Keep wound clean, dry and dressed as suggested by your caregiver between warm soaks or warm compresses.

  • Soak in warm water for fifteen to twenty minutes three to four times per day for bacterial infections. Fungal infections are very difficult to treat, so often require treatment for long periods of time.

  • For bacterial (germ) infections take antibiotics (medicine which kill germs) as directed and finish the prescription, even if the problem appears to be solved before the medicine is gone.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have redness, swelling, or increasing pain in the wound.

  • You notice pus coming from the wound.

  • You have a fever.

  • You notice a bad smell coming from the wound or dressing.