Paronychia

What is paronychia?

Paronychia, also known as whitlow, is an infection in the area where the finger or toenail meets the skin. This can happen either at the side or the base of the nail.

Paronychia is one of the most common infections of the nails, and can happen after injury to the finger or sometimes even spontaneously. The area where the finger connects to the nail is prone to small cuts which can get infected by bacteria. The skin will then become red, inflamed and filled with pus, a white fluid made of dead white blood cells.

Paronychia can be grouped into two types:

• Acute – A short-term infection, no longer than 6 weeks, that only affects one finger or toe and goes away after a few weeks.

• Chronic – A long-term infection that affects several of your fingers or toes. It can heal and then come back again several times.

What are the symptoms of paronychia?

The symptoms of paronychia tend to start a few days after damaging the finger or toe. Common symptoms of paronychia include:

• Red, swollen skin surrounding the nail, like on the base or side of the nail

• Throbbing pain around the nails

• Pale nail beds

• Growth of an abscess (a sore, white spot which might burst, releasing pus)

• The nail may become thicker or change shape

In severe cases, paronychia can cause you to develop a fever, feel unwell and have tender lymph nodes.

How common is paronychia?

Paronychia is 3 times more common in women than in men, and usually happens in people that have their hands or feet in water for long periods of time.

It’s also common in children as a result of nail biting or sucking their thumbs, which can damage the skin around the nail and transfer bacteria from the mouth into any open cuts.

What causes paronychia?

Acute paronychia is usually caused by bacterial infections on the area of the finger or toe that has been damaged recently. These infections tend to be from bacteria that live on our own skin, like Staphylococcus aureus or Streptococcus pyogenes. But in some cases, it can also be a fungal or viral infection, like candida or the herpes simplex virus.

Chronic paronychia is a slower process. It can either be caused by infection or irritation. It usually happens in people that work in jobs where their hands remain wet, like bartenders, housekeepers or dishwashers, but also in people that have a weak immune system, like in diabetes, HIV or cancer, or take medication that weakens their immune system.

How is paronychia diagnosed?

Usually, your doctor may want to ask you a few questions and examine your nail. This is usually enough for them to confirm paronychia.

How is paronychia treated?

Treatment for paronychia depends mostly on how severe the infection is.

In mild cases, soaking the finger in warm, salty water 4 times a day can help. Antiseptics, like chlorhexidine, iodine or TCP, can also be used to clean the wound. Ibuprofen or paracetamol can be given to reduce pain. 

In severe cases, your doctor may want to give antibiotics to help with the infection. They could either give this in a cream which you can spread over the wound, or as a tablet to swallow. They are both effective ways of treatment

If you have an abscess, your doctor may want to make a cut in it and drain away the pus, which will help it heal and reduce the pain.

You will know if your paronychia is improving if the sharpness of the pain or redness starts to decrease from around 36 hours after treatment. The finger will still be a bit swollen and red for a few weeks after, but this is normal as it is a slow process of healing. After a few weeks, your finger should go back to normal and you should have a healthy nail. If you did lose a nail, it may take up to a year to fully grow back

When should I speak to a doctor?

Even though most people only get the typical symptoms from paronychia, rarely this might cause more important problems:

• The infection causes an abscess

• The infection may get worse and spread to the hand, causing cellulitis and infectious tendonitis

• The nail may become yellow, brittle and may fall off

If you feel like the problem is getting worse after about 6 weeks or is spreading to the rest of the finger or the hand, please talk to your GP as soon as possible.

As children are more vulnerable to complications from paronychia, you should take them straight to A&E if any of these happen:

• Your child develops a fever or becomes unwell

• Their finger/toe becomes more red, swollen or painful

• They are unable to bend their finger and is painful when trying

How can Livi help?

A Livi doctor can talk to you about your symptoms and give you advice on the next best steps. They can prescribe antibiotics if needed but can also direct you to the best place to get care.