What is Paronychia?
Paronychia is a bacterial or fungal infection that occurs in the skin around the nails of the toes or fingers, either with or without any apparent cause or as a result of injury. It occurs where the nail and skin meet – mostly around cuticles or along the sides of the nails – and results in swelling, soreness and sometimes pus. This is one of the more common infections people encounter and is classified as one of the most common nail disorders.
Paronychia comes in two forms: acute paronychia and chronic paronychia. With acute paronychia, symptoms appear quickly within hours to days and focus around the nail fold. Common signs include pain, swelling and redness around the nail. Warmth in that area can be felt upon touch, and there’s the possibility of pus build-up, leading to an abscess. The pus discharge can be very painful for some. The condition is caused by bacteria — mainly Staphylococci (staph) — and occurs rapidly within six weeks after injury or trauma, such as picking at hangnails.
In contrast, chronic paronychia unfolds slowly and can last beyond six weeks, often affecting multiple nail folds seen on the toenails, especially those exposed to environmental irritants or work-related materials. It may be associated with fungus infection caused mainly by the Candida species. If left untreated, this type of infection can cause nails to thicken, change colour, and even detach from the bed. Chronic infections often cause ridges or waves on affected nails and a recurring discharge of pus with pain.
Although not severe, paronychia can still affect daily comfort. It occurs in both adults and children but affects women more than men. Whether acute or chronic, seeking treatment immediately is crucial to minimise its effects and recovery.
Diagnosing Paronychia
Diagnosing paronychia usually starts with the healthcare provider, like a podiatrist, conducting a physical examination. The classic signs of acute paronychia that are looked for during this exam are redness, swelling and pain around the lateral nail folds. Other signs, like soft spots suggestive of an abscess or extensive skin blanching, may also be present. For some, paronychia causes throbbing pain around the nail.
Further tests may be needed to pinpoint exact infections through lab work if more serious. Knowing the exact diagnosis is important to create a paronychia treatment plan and address the issue before it worsens.
Management of Paronychia
Treatment options for paronychia vary depending on the severity of the infection. Basic at-home care can manage mild cases. For severe cases, professional medical attention is necessary to avoid complications, including antibiotics or surgical procedures.
Home Remedies
For minor cases of acute paronychia, one common self-care approach is to soak the affected nail in warm water several times a day, about 3-4 times. This helps to reduce inflammation and push out pus if present. Drying the skin around the nail thoroughly is important to prevent further infection.
In addition to soaking in warm water, using antiseptic ointments can also help curb bacterial growth, reduce paronychia pain, and aid recovery. If there’s no improvement in symptoms after a few days of using these home remedies, it’s best to seek expert medical help.
Medical Interventions
For acute paronychia, various treatment options may be used, such as warm compresses, topical antibiotics, oral antibiotics, and surgical drainage if an abscess has formed. Healthcare providers may prescribe stronger antibiotics or drain accumulated pus if the infection persists.
Chronic paronychia requires a different management plan. This may involve antifungal medications for fungal-based infections or antibiotic treatments for bacterial-induced conditions. Additional interventions include topical steroids or minor surgery on the nail. If traditional treatments don’t work for chronic paronychia, surgical measures like en bloc excision of the proximal nail fold may be considered.
How a Podiatrist Can Help
Podiatrists are key in managing paronychia, especially when it’s severe or persistent. The Foot Practice offers guidance on avoiding injuries and emergencies, skin and nail care, and managing related conditions. We can help to manage the underlying fungal and bacterial infections on the nail fold while keeping the patient comfortable.
The Foot Practice aims to prevent future foot problems and ward off long-term foot conditions by using effective interventions.
Preventing Paronychia
Good hygiene and nail care are key to preventing paronychia. There are a few simple steps: keep your feet dry, practice good manicuring techniques, and don’t injure your nails. Wearing moisture-wicking socks is essential for those whose feet are consistently wet, such as long-distance runners. Regularly washing and moisturising dry skin around the nails is crucial in protecting the skin and cuticles from infection.
Following these preventive measures will decrease your risk and promote healthy nails.
Complications of Untreated Paronychia
If paronychia is not treated, it can lead to serious consequences, especially for those who have weakened immune systems. In its more extreme forms, the infection can spread to deeper layers of tissue and possibly reach systemic levels or affect underlying tendons in the foot. Diabetics have a higher risk of complications from infections that can spread to deeper tissues and bones.
Neglecting chronic paronychia can lead to severe nail deformities known as nail dystrophy, where the nail plate becomes thickened, warped, and discoloured. The surrounding nail can deteriorate, causing recurring acute inflammation episodes with pain and potentially leading to nail detachment from the adjacent skin. Prolonged inflammation may increase susceptibility to secondary infections, including periungual warts or excessive scar tissue formation around the nail.
Neglecting paronychia increases the risk of pus accumulating under the nail surface and, thereby, necessary surgical intervention, which may lead to toe amputation in rare cases. Treating this condition early prevents damage to the toe.
Prognosis and Long-Term Management
The outcome of paronychia depends on the type and severity of the infection. Acute paronychia can clear up in a few days with treatment. Chronic paronychia, typically caused by prolonged irritation or fungal infections, may take weeks or months to resolve fully. In severe cases, nail changes can take up to a year to grow out completely.
Long-term strategies include diligent nail care and avoiding the triggers to prevent future episodes of this condition. Managing chronic paronychia cases requires keeping the nails dry, protecting them from harsh chemicals, and following a regular care routine.
Contact The Foot Practice
If you’re experiencing symptoms of paronychia or have concerns about your nails, don’t hesitate to contact The Foot Practice. Our podiatrists are here to provide expert care and guidance tailored to your needs. Our podiatrists will develop a management plan to keep your nails healthy and infection-free, whether you’re dealing with acute or chronic paronychia.
At The Foot Practice, we understand the importance of timely intervention and prevention. Our foot specialists are here to help you manage paronychia effectively and provide solutions for healing and prevention. Contact us today to book a consultation and take the first step to optimal nail health.
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Frequently Asked Questions
What is paronychia?
Paronychia is an infection of the tissue around the toenails and fingernails caused by bacteria or fungi. Seek treatment from medical professionals like a podiatrist to prevent complications.
What causes paronychia?
Paronychia is caused by bacterial infection when bacteria enter the skin through cuts in the cuticle and nail fold. Fortunately, most cases can be treated with antibiotics.
What are the symptoms of acute paronychia?
Acute paronychia causes the area around the nail to become painful, swollen, red, warm and may have pus. Timely recognition and treatment are crucial to prevent complications.
How can I prevent paronychia?
To prevent paronychia, keep your feet dry, don’t pick at your nails, and practice good pedicuring techniques. Following these steps will decrease the risk of developing this condition.
What treatments are available for chronic paronychia?
Chronic paronychia can be treated with antifungal medications, antibiotics, topical steroids and, in severe cases, surgical intervention. See a healthcare professional for a customised treatment plan.
Can paronychia spread to other nails?
Paronychia is usually limited to one nail and does not ‘spread’ like other fungal or bacterial infections. However, a similar impact on the foot or poor foot hygiene can increase the likelihood of paronychia across different toes.
