Paronychia: Finger and toenail infections

Paronychia is an infection that involves the perionychium or skin that hangs over the side of the nails. It is the most common form of hand infection and normally occur among children as a result of nail biting and sucking on the finger. The condition is categorized as either acute or chronic paronychia depending on the amount of time the infection has been present.

Possible causes of paronychia

Both acute and chronic infections begin with any cut or break in the upper skin layer. An acute infection is linked with disturbance to the skin such as an ingrown nail, hangnail or even biting the nails. The prevalent bacteria accountable is the Staphylococcus aureus.

Other bacteria that are uncommonly involved include streptococcus and pseudomonas. As for chronic infections, it is often linked with recurrent irritation including being exposed to water and detergents. Most cases of chronic infections are triggered by Candida albicans or other forms of fungi.

Characteristics of acute paronychia


Acute paronychia starts out as a warm, reddened, painful swelling of the skin surrounding the nail.

Acute paronychia starts out as a warm, reddened, painful swelling of the skin surrounding the nail. This can progress to the development of pus that splits with the skin from the nail. Additionally, the lymph nodes in the armpit and elbow might swell as well.

Characteristics of chronic paronychia

In chronic cases, the tenderness and redness are less evident than acute cases. The skin that surrounds the nail can become boggy. The nail might even end up with a greenish discoloration due to a pseudomonas infection.


Paronychia is diagnosed based on the clinical symptoms. Oftentimes, if pus is involved, a culture might be taken to pinpoint the bacteria involved. This is not needed in most cases since the bacteria is usually assumed as streptococcus or staphylococcus species.


Warm soaking can be utilized 3-4 times a day for acute cases of paronychia to stimulate drainage and alleviate some of the pain. In most acute cases, it requires treatment using antibiotics. Topical antibiotics or certain forms of anti-bacterial ointments could not effectively manage the condition.

In case there is pus or an boil present, the infection might require incision and drainage. In rare circumstances, a part of the nail might be removed.

In chronic cases, it requires treatment using topical antifungal medications. A mild topical steroid particularly hydrocortisone can be added to the antifungal medication to minimize the inflammation.


  • Avoid biting nails or cuticles
  • Avoid sucking on fingers
  • Avoid soaking the hands in water without using waterproof gloves


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