Additional information

Paronychia or nail bed infections

• Paronychia or nail bed infections are common and can affect anyone, causing pain, swelling, and sometimes pus around the fingernails or toenails [1][2].
• Acute paronychia is usually caused by bacteria entering through broken skin, while chronic paronychia results from repeated irritation and damage to the nail folds [1][2].
• Treatment for acute paronychia includes warm soaks, topical or oral antibiotics, and drainage of any pus, while chronic paronychia is managed by avoiding water and irritants [1][2].
• Good nail care and avoiding trauma can help prevent both types of paronychia [1][2].
• This guide is packed with practical tips, relatable examples, and evidence-based advice to help you manage and prevent nail bed infections [1][2].

What is paronychia or a nail bed infection?

Paronychia is the medical term for inflammation or infection of the skin around your fingernails or toenails. It can be sudden (acute) or long-lasting (chronic). Acute paronychia is usually caused by bacteria, while chronic paronychia is more about irritation from water, chemicals, or repeated trauma [1][2].

Who gets paronychia or nail bed infections?

Anyone can get a nail bed infection, but you’re more likely to develop paronychia if you bite your nails, pick at your cuticles, have frequent manicures, or work with water and chemicals a lot. Chronic paronychia is especially common in people whose hands are often wet or exposed to cleaning products, like hairdressers, cleaners, and chefs [1][2].

How does paronychia or a nail bed infection develop?

Acute paronychia happens fast, usually after the skin around the nail is damaged. Bacteria like Staphylococcus aureus sneak in and cause redness, swelling, and sometimes pus. Chronic paronychia, on the other hand, develops over weeks or months due to repeated irritation and loss of the protective cuticle, letting irritants and sometimes yeast hang around the nail folds [1][2].

What are the symptoms of paronychia or nail bed infections?

Symptoms can vary depending on whether the infection is acute or chronic, but typically include:

• Redness and swelling around the nail fold
• Pain and tenderness, especially when touching or using the finger or toe
• Warmth and sometimes throbbing
• Pus or fluid-filled blisters (more common in acute cases)
• Changes in the nail, like ridges or grooves (more common in chronic cases)
• Loss or damage to the cuticle (especially in chronic paronychia)

If left untreated, an acute infection can turn into an abscess (a pocket of pus) [1][2].

How is paronychia or a nail bed infection diagnosed?

Diagnosis is usually straightforward. Your healthcare provider will look at the affected nail and ask about your symptoms and recent activities. Sometimes, if there’s a lot of swelling or pus, or if they suspect a deeper infection, they might use an ultrasound [1][2].

Treatment for acute paronychia or nail bed infections

Warm soaks: Soak the affected finger or toe in warm water for 15 620 minutes, three to four times a day. This helps reduce swelling and encourages drainage. Adding Burow solution (aluminium acetate) or diluted vinegar (1% acetic acid) can also help [1][2].

Topical antibiotics: If warm soaks don’t clear things up, your doctor might suggest an antibiotic cream like mupirocin or gentamicin to apply directly to the area [1].

Oral antibiotics: These are usually only needed if the infection is severe, spreading, or if you have a weakened immune system. Your doctor will choose the antibiotic based on the likely bacteria and local resistance patterns [1][2].

Abscess drainage: If there’s a pocket of pus, your healthcare provider might need to drain it using a needle or small incision. This is often done under local anaesthetic and usually brings quick relief [1].

Practical tips for healthy nails

• Don’t bite your nails or pick at the skin around them
• Keep your nails trimmed and clean
• Moisturise your hands regularly
• Wear gloves for wet work or when handling chemicals
• Treat hangnails gently 6never rip them off

When to seek urgent medical help

• If you develop fever, chills, or feel generally unwell
• If redness, swelling, or pain spreads beyond the nail area
• If the infection doesn’t improve after a few days of treatment
• If you have diabetes, a weakened immune system, or poor circulation [1][2]

Who, how, and why: who is this guide for, how does it help, and why does it matter?

This guide is for anyone who wants to understand, treat, or prevent paronychia or nail bed infections. It’s especially helpful for people who work with their hands, those prone to nail biting or picking, and anyone who wants healthier, pain-free nails. By learning about causes, symptoms, and treatments, you can take control of your nail health and avoid future infections [1][2].

Disclaimer: This article is for informational purposes only and does not replace professional medical advice.

References

1. Leggit, J.C., 2017. Acute and chronic paronychia. American Family Physician, 96(1), pp.44-51.
2. NICE Clinical Knowledge Summary: Acute paronychia management.