Paronychia: Causes, Symptoms, and Treatment Guide

Paronychia is an infection of the skin folds surrounding the fingernails or toenails. It is typically caused by bacteria (commonly Staphylococcus aureus) or fungi (Candida species), and can present as either acute or chronic.

Types of Paronychia

• Acute Paronychia: Sudden onset, usually very painful, often following minor trauma (hangnail, nail biting, manicure). Presents with rapid redness, swelling, throbbing pain, and pus formation.
• Chronic Paronychia: Persists for more than six weeks, often less painful but with recurrent flare-ups. Common in individuals with frequent water exposure, diabetes, or immune compromise. The nail plate may become distorted, discolored, or detached.

Risk Factors

• Frequent hand washing or wet work (dishwashing, healthcare, food handling)
• Nail biting, cuticle picking, or aggressive manicures
• Diabetes mellitus or immunosuppressive conditions
• Chemotherapy or prolonged antibiotic use
• Ingrown toenails or foot trauma

Symptoms

• Pain and tenderness around the nail
• Redness and swelling of the nail fold
• Pus-filled blisters or drainage
• Nail plate changes (ridging, discoloration, separation)
• Fever (in severe acute cases)

Treatment

Acute: Warm soaks 3-4 times daily, topical antibiotics (mupirocin), oral antibiotics if spreading (cephalexin, clindamycin). Incision and drainage if abscess forms.

Chronic: Topical antifungal/anti-inflammatory agents (clotrimazole + hydrocortisone), avoiding irritants, keeping hands dry, gloves for wet work. Refractory cases may require surgical marsupialization or nail removal.

Prevention

• Keep hands and feet clean and dry; wear cotton-lined gloves for wet tasks.
• Avoid nail biting, cuticle cutting, and aggressive manicures.
• Trim nails straight across; treat minor nail injuries promptly.
• Manage underlying conditions (diabetes, eczema).