Nail Infection (Paronychia)
Paronychia, commonly called a nail infection, is inflammation of the region of the finger or toe next to the nail, either at the proximal nail fold (the base of the nail) or at the lateral nail fold (on either side of the nail). Paronychia is usually caused by a bacterial infection, but it can also be caused by a virus, typically the herpes simplex virus. It can also be caused by certain medications, such as retinoids. The inflammation may occur suddenly (acute paronychia), or it may be a more low-grade long-term problem or one that keeps coming back (chronic paronychia). Chronic paronychia is usually caused by chronic irritation of the nailfold rather than an infection or a drug side effect, and yeast (Candida) may then colonize the area.
In many cases of acute paronychia, there is first some sort of trauma to the nail fold (eg, a splinter, fingernail biting, tearing away a hangnail, cutting the skin while trimming the nails) that allows bacteria to enter, resulting in infection. Acute paronychia develops fairly quickly, over a period of days.
Who's At Risk?
Paronychia may occur at any age, but acute paronychia is particularly common in children, especially in children who suck on their thumb or fingers or whose caregivers over-trim their fingernails.
Signs & Symptoms
Acute paronychia most often affects the nail fold of the thumb or fingers, or sometimes the toes.
The affected nail fold may be red, swollen, tender, and there may be an abscess (a tender bump containing pus). In the case of acute paronychia, usually only one nail is affected.
Self-Care Guidelines
If the nail infection is affecting just one or two nails and it’s an acute case, you can try having the child soak the affected nail or nails in warm water for 15 minutes 4 times a day until symptoms resolve. You can also apply an antibacterial ointment (eg, Neosporin or triple antibiotic containing neomycin, polymyxin B, and bacitracin) to the affected area 2-3 times a day.
In the case of chronic paronychia, the child should avoid moisture exposure to the nails. (They should avoid sucking their thumb or fingers, if applicable.)
Treatments
Your child’s medical professional may puncture and drain the affected area and test for bacteria. Depending on the severity of the infection, the medical professional may prescribe a topical antibiotic or oral antibiotic.
Visit Urgency
Seek medical care if the infection does not get better within 48-72 hours of self-care. If there is severe pain, spreading redness, or fever, seek medical care more urgently.
References
Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.
James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.
Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.
Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6th ed. St. Louis, MO: Elsevier; 2022.
Last modified on July 10th, 2024 at 11:02 am
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