Nail infection paronychia

Paronychia of the finger (according to ICD 10 code L03.0) occurs in adults and children. This is an inflammation of the lateral and proximal nail folds or skin folds that surround the nail. The main reason for starting the inflammatory process is the destruction of the protective barrier, which prevents foreign particles and pathogenic microorganisms from penetrating deep into the skin.

According to statistics, paronychia in girls and women occurs 5 times more often than in men. Out of the desire to be beautiful, women subject their nails to various, not always safe procedures. The highest risk of infection is in middle-aged women. In another way, the disease is called paronychia periungual felon. There is an acute and chronic form of inflammation. Their causes and treatments are different.

General information

By the nature of the course, paronychia happens:

• • Sharp. It is found quite often, has a bacterial nature. Lasts less than 6 weeks. It is accompanied by severe pain, the formation of pus;
  • Chronic. If the inflammation continues for more than 6 weeks, then it means that this is chronic paronychia. It is caused by mechanical, chemical factors, contact dermatitis, onychomycosis, eczema, psoriasis.

Depending on the nature and severity of the inflammatory process, the following types of paronychia are distinguished:

• • Simple. It is characterized by slight swelling, redness, moderate pain in the area of the nail fold.
  • Purulent. Its symptoms include severe throbbing pain, a feeling of squeezing, pronounced edema in the area of the affected nail fold. In places where the pus accumulates, the skin acquires a yellow tint, when pressed, pain is felt.
  • Ulcerative. Painful ulcerations form on the surface of the nail ridges, from which pus is periodically released.
  • Fungal (candidal paronychia). Caused by fungi of the genus Candida. Symptoms are mild. There is a slight reddening of the skin, disappearance or reduction of the cuticle, changes in the nail specific for onychomycosis.
  • Paronychia with eczema or psoriasis. It is characterized by moderate inflammation, peeling, the appearance of blisters on the skin, which form crusts as they dry.

Due to the onset of the inflammatory process, paronychia is:

• • Bacterial. Acute forms in most cases are caused by Staphylococcus aureus, chronic - streptococci, and pseudomonas. In children, acute forms resulting from the habit of biting nails or sucking fingers are associated with infection of the nail tissue with aerobic and anaerobic bacteria in the oral cavity.
  • Viral. It is caused by the herpes simplex virus.
  • Fungal. It develops against the background of infection of the tissues of the nail folds with yeast-like fungi of the genus Candida.
  • Non-infectious. It is caused by contact irritants, excessive moisture, side effects of certain medications, and chronic skin diseases.

What causes inflammation around the nail?

In order to understand exactly where the inflammation occurs in paronychia, we will analyze how the nail and the soft tissues around it are arranged. The nail apparatus has a complex structure. It consists of five main structures: the nail plate, matrix, nail bed, cuticle, and nail folds.

The cuticle is an important protective element, it connects the skin of the finger and the nail plate together. Mechanically protects against irritants, allergens, pathogenic microorganisms from getting under the nail from the side ridges and the growth zone. Another feature of this skin above the nail is that it does not contain blood vessels and nerve endings.

That is why we do not feel pain and do not see blood when the manicurist cuts the cuticle. But, on the other hand, the lack of blood supply means the lack of local protection from external foreign bodies, irritants, pathogenic agents. This function is performed by leukocytes - white blood cells. Therefore, in the event of injury to the cuticle, negative factors do not encounter obstacles and immediately go deeper.

The main factor that causes acute paronychia is infection. Even with a minor injury to the cuticle, destruction of the integrity of the skin on the nail ridges, pathogenic microorganisms penetrate deep into the tissues of the nail apparatus. In 60% of cases, inflammation develops due to strains of Staphylococcus aureus (Staphylococcus aureus). Infection with mixed pathogenic microflora and streptococcus is possible.

More often, paronychia occurs on the hands. Fingers, unlike feet, are more in contact with the environment, subject to mechanical injury, contact with water, aggressive substances, and potential sources of infection. Cracks invisible to the eye, the presence of which you may not even suspect, become the gateway for the penetration of pathogenic bacteria and fungi, provoke inflammation.

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The most common causes of paronychia include:

• • poor disinfection of hands or tools during a manicure or pedicure.
  • splinters, abrasions, cuts, scratches in the area around the nail.
  • torn off or bitten off burrs.
  • the habit of biting nails.
  • tight, uncomfortable shoes (causing paronychia on toes)
  • ingrown nails.
  • wearing artificial nails.
  • a fungal infection of the skin or nails (onychomycosis).
  • sloppy or improper nail trimming at home.

Thumb sucking can cause inflammation of the nail folds in young children.

Chronic paronychia is an inflammatory reaction that occurs in response to irritants or allergens. If in the acute form, as a rule, only one nail is affected, then in the chronic one - several at the same time. These are usually the thumb, forefinger, and middle fingers of the working hand.

Chronic paronychia develops as a result of irritating contact dermatitis or fungal infection.

It is often found in housewives and people of certain professions in contact with irritating substances, high humidity. These professions include cleaners, laundry workers who are constantly in contact with water, powders, weak alkalis, acids, detergents, and household cleaning agents.

Also at risk are professions related to the kitchen, cooks, bartenders, dishwashers. Fungal paronychia caused by a fungus of the genus Candida, in everyday life, is called the disease of bakers or confectioners. Constant contact with moisture, dough, sugars creates favorable conditions for the development of such fungal infection.

The chronic form of inflammation of the skin around the nail is often found in employees of chemical laboratories, people who work with fuels and lubricants. At-risk are professional swimmers, whose hands and feet are in constant contact with water and pool disinfectants.

With the constant action of aggressive substances, the protective barrier of the nail is gradually destroyed, which leads to inflammation.

Chronic paronychia is common in people with diabetes mellitus, chronic skin conditions such as eczema and psoriasis. Long-term use of certain medications can also cause it. For example, drugs from the group of retinoids and protease inhibitors.

What are the characteristics of paronychia?

The symptoms of paronychia depend on the form of the disease. If the protective barrier between the nail and the nail fold is violated, pathogenic microorganisms or aggressive substances enter there, which triggers the growth of pathogenic microflora and the inflammatory process.

In acute paronychia, inflammation develops rapidly. The first signs make themselves felt 1 - 2 days after the injury. These include redness of the damaged area, swelling, soreness when pressed, and a local increase in temperature. In the future, there is an accumulation of purulent masses under the skin, which shine through in yellow or yellow-green color. At the same time, swelling increases, the nail roller rises, the finger becomes painful not only when pressed, but also at rest. Flexion of the upper phalanx of the finger is difficult, inside there is a feeling of fullness. With strong pressure, it is possible to discharge pus from the nail sinus, the gap between the nail bed and the nail roller.

Paronychia in a small child initially causes moodiness, sleep problems. Then the baby's finger turns red, swells. The inflamed area becomes hot to the touch, touching it is very painful. The child cries, pulls away the sore finger when the parents try to examine it, cannot bend it.

The chronic form of inflammation develops slowly, does not cause severe pain. The fold of the nail may be red and swollen. There is no throbbing pain. The accumulation of pus is possible only during exacerbations. The skin on the nail roller can flake off, exfoliate. Long-term chronic inflammatory processes lead to degenerative changes in the nail and the disappearance of the cuticle. The shape, structure of the nail plate changes, its thickening, discoloration is observed.

Fungal and bacterial forms of infection differ in the intensity and localization of the inflammatory process. With fungal paronychia caused by infection with a fungus of the genus Candida, redness and swelling are observed. When pressing on the roller, pain is noted. With a prolonged course, transverse grooves form on the nail, the periungual skin exfoliates. The inflammatory focus is located between the nail skin itself and the outer surface of the nail plate. A bacterial infection is characterized by severe throbbing pain, the inflammatory focus is located in the soft tissues of the nail fold and does not touch the nail plate.

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Nail Infection Paronychia Diagnostics

If you suspect acute paronychia, see a podiatrist or surgeon if there is no podiatrist nearby. The diagnosis is made on the basis of clinical symptoms, interviewing a person, examining the affected area. It is important to talk about the specifics of your work, previous injuries in the nail area. The doctor will check if there is an accumulation of purulent masses (abscess), assess the severity of the condition, and decide on the method of treatment.

When diagnosing paronychia, it is important not to confuse the disease with other possible disorders in the area of the nail plate with similar symptoms.

These include:

• • Superficial infection that manifests as erythema and edema in the affected area without throbbing pain.
  • Panaritium or purulent inflammation of the deep layers of the skin of the finger. It is characterized by a severe course. Paronychia is considered the initial stage of panaritium. With panaritium, redness, soreness and the formation of a blister with purulent contents do not necessarily occur next to the nail. The affected area becomes warm, red, tense, and very painful.
  • Herpetic infection of the distal (upper) phalanx of the fingers. In this case, before the onset of the inflammatory process, the person will experience a burning sensation, itching. Herpes infection of the fingers is characterized by the formation of vesicles, pain, redness.
  • Onychomycosis. This is a fungal infection of the nail that causes a cloudy, yellowish discoloration of the nail plate.
  • Squamous cell carcinoma. It mainly affects the skin, but sometimes also affects the nail bed. It is a rare malignant subungual tumor that can be mistaken for chronic paronychia.

In addition, it is important to carry out differential diagnostics with eczema, psoriasis, and Reiter's syndrome (joint damage that can cause accumulation of pus in the area of the nail fold).

Instrumental diagnostic methods such as X-ray, ultrasound, laboratory tests are prescribed only if the observed clinical picture of paronychia is atypical and raises doubts about the diagnosis.

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Nail infection paronychia treatment?

It is better to entrust the treatment of paronychia on the hands or feet to a doctor, especially if it is a purulent inflammation. Refer this problem to a podiatrist, surgeon, or dermatologist. He will examine the affected area, assess the severity of the infection, cleanse the pus, and select medications for further home use. If necessary, he will send for additional examinations, analysis of purulent contents to identify a specific pathogen.

Attempts to treat paronychia at home, and especially squeezing out pus, are dangerous by the transfer of infection to neighboring tissues, by the addition of new pathogenic pathogens.

The indication for surgical intervention is inflammation of any form if it is accompanied by an accumulation of pus.

Therefore, see your doctor if you experience any of the following symptoms :

Redness, swelling, and soreness of the skin at the base of the nail plate or in the area of the lateral nail ridges ;

Suppuration, which caused detachment of the skin and nail plate, discharge of pus ;

A sharp increase in pain when pressing on the nail and fingertip.

Acute Paronychia Treatment

Treatment of acute paronychia is determined by the severity of the inflammation and the presence of an abscess. If there is an abscess, it should be cut open to remove the pus. Without this procedure, the condition will only get worse.

Inflammation with an accumulation of pus in the nail fold is treated with a small operation. Removal of paronychia and purging of pus are performed through small incisions using local anesthesia or needle punctures without anesthesia. This procedure is necessary to remove the pus that has accumulated under the skin. In severe cases where the abscess extends to the nail bed or is associated with an ingrowing nail, part of the nail plate may need to be removed.

Of the local drugs for the treatment of paronychia, ointments are used to fight bacterial infection. Anti-inflammatory and antibacterial agents of a wide spectrum are used, which must be effective against Staphylococcus aureus. After removing the pus on the resulting wound, the doctor applies a sterile gauze bandage with medicated ointment. As soon as the pus starts to come out, the person immediately feels relief. The throbbing pain and tension go away.

For severe inflammation, antibiotics can be given by mouth. This is necessary for severe infections, immunodeficiency conditions, or if it is not possible to provide adequate drainage for the outflow of pus.

After draining, it is important to follow all the recommendations of the doctor performing the procedure to prevent secondary infection. After a few days, the patient should again see a specialist to assess the condition of the periungual tissues. With proper care after draining the abscess, the affected toe heals quickly without any complications.

If the dissection of paronychia occurs on its own, treat the wound with an antiseptic. Use a solution of chlorhexidine, hydrogen peroxide, furacilin for this. Wrap with a sterile bandage and see your doctor for further care advice.

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Paronychia Treatment at home

Is it possible to cure paronychia on your own at home?

It is possible, but only in the initial stages when there is still no formation of pus. With inflammation without an obvious abscess, warm baths with antiseptic solutions (chlorhexidine, povidone-iodine), salt baths help. They need to be done 4 – 5 times a day for 10 – 15 minutes. If the condition does not improve within two days, see a doctor for paronychia. It is not recommended to use anti-inflammatory and antibacterial ointments on their own. Such drugs should be prescribed by a doctor.

With timely referral to a specialist, the treatment of an acute form of inflammation has a favorable prognosis. The condition improves within a few days. If acute paronychia is constantly repeated, then it develops into a chronic one. Therefore, patients should take measures to avoid future injuries in the area of the nail folds.

Paronychia treatment with concomitant skin diseases

If the cause of acute paronychia is associated with psoriasis or eczema, then treatment in these cases should be directed at the root cause. See your dermatologist and let them know about your nail problem.

Eczema and psoriasis are not contagious chronic skin diseases; their course consists of alternating periods of exacerbation and remission. Unfortunately, it is not yet possible to completely get rid of them. The main goal of treating these diseases is to relieve symptoms and achieve permanent remission.

Oral medications, local ointments and creams, and physiotherapy help. Quitting bad habits, strict adherence to a diet, and avoiding nervous stress are of great importance. Since it is often these factors that become the trigger for the onset of exacerbation. Foods that cause allergies, alcohol, sweets, as well as fatty, spicy, smoked foods that are difficult to digest should be excluded.

During exacerbations, the skin turns red, inflamed, begins to peel off, itch. Ulcers and a rash may appear on it. It is important to avoid complications in the form of a secondary bacterial or fungal infection, as this leads to paronychia and slower skin regeneration.

Paronychia treatment of the chronic form

Treatment of chronic paronychia is aimed at identifying and eliminating the source of irritation. You need to prepare for the fact that it will be long, it will take from several weeks to several months, depending on the severity of the condition. The fact is that chronic paronychia is slow to respond to treatment.

In a chronic inflammatory process, whenever possible, they try to exclude contact with an irritant, prescribe local anti-inflammatory and restoring the protective functions of the skin.

If paronychia occurs as a result of taking certain medications, then the doctor and the patient must decide together whether the adverse effects of such treatment are acceptable for the therapeutic effect of the drug. Or you should think about choosing another drug. Stopping the intake of a medication that provokes inflammation will allow you to quickly restore the periungual tissues, remove irritation and discomfort.

If the cause is a fungal infection, local antifungal agents are prescribed in the form of ointments, gels, solutions. If necessary, the area damaged by the fungus is cleaned with a hardware medical manicure or pedicure.

The success of the treatment of chronic paronychia largely depends on the fulfillment of the doctor’s instructions and the prevention, which the patient will carry out independently.

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Possible complications

With timely treatment of paronychia, fingers or toes are quickly cured. If you delay and wait for everything to pass by itself, then the infection will even reach the muscles, tendons, bones of the finger, and get into the systemic circulation. The accumulation of pus can undermine the nail, lead to its detachment from the nail bed. In advanced stages, partial or complete removal of the nail plate with long-term rehabilitation is often required.

The main complication of chronic paronychia is nail dystrophy caused by inflammation in the area of the nail matrix. It manifests itself in the form of fragility, delamination of the nail plate, distortion of the shape, the formation of grooves, grooves. Changes in the color of the nail plate are possible.

How to prevent paronychia?

To prevent inflammation around the nail, practice good personal hygiene. Proper nail care will significantly reduce the risk of infection and keep your nails, nail folds, and nail beds healthy. If accidental injury or irritation occurs, immediately treat the skin around the nail with an antiseptic. Carry an antiseptic spray in your purse. After all, a nuisance in the form of a splinter, cut, scratch, abrasion can happen anywhere, and disinfection of the injured area will prevent infection.

To prevent paronychia, adhere to the following recommendations for the care of nails and skin of hands and feet :

• • Keep your hands and feet dry and clean.
  • Apply a moisturizer after bathing or every time you wash your hands if you have dry skin to help prevent cracking.
  • Avoid prolonged contact with potential irritants (chemicals, household chemicals, varnishes, paints), use protective gloves.
  • Do not bite your nails, do not pick out the skin around them.
  • Do not cut the cuticle, especially on the toenails, the destruction of the nail or cuticle will lead to the ingress of bacteria and fungi.
  • Do not bite off or tear off the barbs, carefully cut them with nail clippers.
  • Do not grow too long nails, regularly trim and smooth sharp edges with a file.
  • Keep your hands away from constant exposure to water, avoid getting irritants or allergens on the skin.
  • Disinfect manicure instruments before the procedure.
  • Keep your blood sugar normal if you have diabetes.
  • Keep your shoes and socks dry at all times, this will help prevent the development of fungal paronychia.

If it was not possible to avoid paronychia, do not be afraid and seek medical help. We will always be happy to help you at the Eva Korneeva Podology Center. With us, you can quickly, safely, and painlessly cure inflammation around the nail. All manipulations are performed under conditions of 100% sterility without the risk of complications. A quick rehabilitation after the procedure will allow you to return to your business, but without any pain and discomfort in your fingers.

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