ConditionSkin, hair & nails
Paronychia (Nail Fold Infection)
Paronychia is an infection of the skin fold around a fingernail or toenail. Acute paronychia develops over hours to days, usually after a hangnail, nail biting or a manicure, and causes a red, swollen, painful nail fold that may fill with pus. It is usually caused by bacteria and often improves with warm soaks, though an abscess needs draining. Chronic paronychia lasts 6 weeks or more, typically in people whose hands are often wet, and is treated by keeping the hands dry and using steroid or antifungal creams.
Also called: Nail infection, infected nail fold, whitlow (informal), infected hangnail, nail bed infection
At a glance
- What it is
- Infection of the skin fold around a nail.
- Acute
- Sudden, painful, often with pus; usually Staphylococcus aureus or streptococci.
- Chronic
- 6 weeks or longer; mostly irritant dermatitis from wet work, sometimes Candida.
- Home care
- Warm water soaks 3 to 4 times a day for mild acute cases.
- Medical care
- Drainage of pus; antibiotics if spreading; steroid or antifungal creams for chronic cases.
When to get help
Call 911 or go to the ER
- Rapidly spreading redness up the hand or arm, red streaks, fever or feeling very unwell. Call 911 or your local emergency number if severe, or go to the ER
See a doctor within a day or two
- A tense, very painful swelling of the fingertip pad (possible felon)
- Pain on moving the finger, or swelling of the whole finger (possible tendon sheath infection)
- A paronychia in someone with diabetes, poor circulation or a weakened immune system
- A visible pocket of pus that is not draining
Book a routine appointment
- A red, sore nail fold that has not improved after 2 to 3 days of soaks
- Nail fold swelling lasting more than 6 weeks, or nails becoming ridged and discolored
- Recurrent infections around the same nail
Usually safe to manage at home
- Mild redness and tenderness next to the nail after a hangnail, without pus or spreading redness
How paronychia develops
The skin folds around the nail and the cuticle form a seal that keeps germs out. When this seal is broken, by biting, picking, a hangnail, manicures, ingrown nails or constant wetness, bacteria or yeast can enter.
Acute vs chronic paronychia
| Feature | Acute paronychia | Chronic paronychia |
|---|---|---|
| Onset | Hours to days | Gradual, 6 weeks or longer |
| Cause | Bacteria (Staphylococcus aureus, streptococci) | Irritant dermatitis from wet work; Candida sometimes involved |
| Typical triggers | Hangnail, nail biting, manicure, ingrown nail, thumb sucking | Frequent hand washing, dishwashing, cleaning, food handling, bartending, healthcare work |
| Nails affected | Usually one | Often several |
| Appearance | Red, hot, swollen, painful, sometimes yellow pus | Swollen, tender, red nail folds; cuticle lost; ridged, discolored nails |
| Treatment | Soaks, drainage, antibiotics | Keep dry, topical steroids, antifungals |
Symptoms
Acute
- redness, warmth and swelling beside or at the base of the nail
- throbbing pain
- a yellow or white pocket of pus (abscess)
- the nail may lift if pus spreads underneath
Chronic
- swollen, boggy, tender nail folds
- loss of the cuticle
- intermittent flares with discharge
- nail changes: ridges, discoloration, thickening
Similar conditions
- Felon: an infection of the fingertip pad, causing tense, severe pain; needs urgent drainage.
- Herpetic whitlow: clusters of small blisters on the finger from herpes simplex virus. It should not be cut open; antivirals are used.
- Ingrown nail: a common cause of toe paronychia.
- Nail psoriasis, eczema and, rarely, skin cancer can mimic chronic paronychia.
Diagnosis
Paronychia is diagnosed by examination. A doctor may press the fingertip gently to see whether pus collects (digital pressure test). Swabs for culture are taken for severe, recurrent or unusual cases, and an X-ray if bone infection or a foreign body is suspected.
Treatment
Acute paronychia
- Warm soaks: soak the finger or toe in warm water (with or without a little antiseptic) for 15 minutes, 3 to 4 times a day. This often settles early infections.
- Topical antibiotic ointment for mild cases.
- Drainage: if there is a pocket of pus, a clinician numbs the finger and lifts the nail fold or makes a small cut to release it. This brings rapid relief.
- Oral antibiotics if redness spreads, after drainage in some cases, or for people with diabetes or immune problems.
- Partial nail removal if pus is under the nail or an ingrown nail is the cause.
- Pain relief with acetaminophen or ibuprofen, following the label.
Chronic paronychia
- Keep hands dry: wear cotton-lined rubber gloves for wet work, dry hands thoroughly, and avoid soaking.
- Topical corticosteroid creams or ointments, the most effective treatment, reduce inflammation.
- Topical antifungals if Candida is present.
- Moisturize the hands and nail folds with a barrier cream.
- Stop cutting or pushing back cuticles.
- Surgery to remove part of the swollen nail fold is rarely needed for stubborn cases.
Prevention
- do not bite nails or pick at hangnails; clip hangnails with clean clippers
- avoid cutting or pushing back cuticles
- use clean manicure tools
- trim toenails straight across
- wear gloves for wet work and dry hands well
- manage diabetes and eczema
Frequently asked questions
How do you treat an infected fingernail at home?
For mild redness and swelling without much pus, soak the finger in warm water for 15 minutes 3 to 4 times a day and apply antibiotic ointment. Keep it clean and dry between soaks. See a doctor if it does not improve in 2 to 3 days or pus develops.
Should I pop a paronychia?
It is safer not to. Squeezing or cutting it yourself can push infection deeper or cause injury. If there is a visible pocket of pus, a clinician can drain it properly under numbing, which gives quick relief. Never cut blisters that might be herpetic whitlow.
How long does paronychia take to heal?
Acute paronychia usually improves within a few days of soaks or drainage. Chronic paronychia can take weeks to months to settle and requires keeping the hands dry and consistent use of prescribed creams.
What causes chronic paronychia?
Chronic paronychia is mostly caused by irritation from frequent wet work, such as dishwashing, cleaning, cooking or healthcare work, which damages the nail folds. Yeast may then colonize the area. Keeping hands dry is the most important part of treatment.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Family Physicians: Acute and chronic paronychia
- American Academy of Dermatology: Nail infections
- American Society for Surgery of the Hand: Paronychia
- MedlinePlus: Paronychia
- DermNet: Paronychia