Paronychia

An Overview

Fungal infections can affect any part of the body. Fungi are normally present in and on the body alongside various bacteria. But when a fungus begins to overgrow, you can get an infection. Onychomycosis, also called tinea unguium, is a fungal infection that affects either the fingernails or toenails. Fungal infections normally develop over time, so any immediate difference in the way your nail looks or feels may be too subtle to notice at first.

Paronychia is an infection of the skin around the nail of at least one finger or toe. It typically develops around the edges of the nail at the bottom or sides. This skin infection causes inflammation, swelling, and discomfort around the nail. Abscesses containing pus can also form. A fungal nail infection occurs from the overgrowth of fungi in, under, or on the nail. Fungi thrive in warm, moist environments, so this type of environment can cause them to naturally overpopulate. The same fungi that cause jock itch, athlete’s foot, and ringworm can cause nail infections.

Fungi that are already present in or on your body can cause nail infections. If you have come in contact with someone else who has a fungal infection, you may have contracted it as well.

There are two types of paronychia:

Acute paronychia. This develops over hours or days. The infection does not usually spread deep into the finger, and treatment can reduce symptoms relatively quickly.
Chronic paronychia. This occurs when symptoms last for at least 6 weeks. It develops more slowly and can become more serious. Chronic paronychia often affects several digits at once.
Distal subungual infection. Distal subungual infections are the most common type of fungal nail infection and can develop in both fingernails and toenails. When infected, the outer edge of the nail has a jagged appearance with white and/or yellow streaks across the nail.
The infection invades the nail bed and underside of the nail.
White superficial infection.White superficial infections usually affect toenails. A certain type of fungus attacks the top layers of the nail and creates well-defined white spots on the nail.
Eventually these white patches cover the entire nail, which becomes rough, soft, and prone to crumbling. Spots on nail may become pitted and flaky.
Proximal subungual infection. Proximal subungual infections are uncommon but can affect both fingernails and toenails. Yellow spots appear at the base of the nail as the infection spreads upward.
This infection can commonly occur in people with compromised immune systems. It can also result from minor injury to the nail.
Candida infection. Candida yeasts cause this type of infection. It can invade nails previously damaged by a prior infection or injury. More commonly, Candida affects fingernails. It often occurs in people who frequently soak their hands in water.

Symptoms for paronychia

Some symptoms of paronychia resemble those of different skin infections. Other symptoms directly affect the nail itself.
Paronychia symptoms include:
• swelling, tenderness, and redness around the nail
• puss-filled abscesses
• hardening of the nail
• deformation or damage to the nail
• the nail separating from the nailbed

Causes of paronychia

The infection occurs when the skin around the nail becomes damaged, allowing germs to enter.
Bacteria or fungi can cause paronychia, and common culprits are Staphylococcus aureus and Streptococcus pyogenes bacteria.
Paronychia: The offending bacteria are usually staphylococcal and streptococcal organisms. Rarely, a fungus causes this infection, which usually begins as a hangnail. Often a person will attempt to bite off the piece of nail that is at the corner. This results in an open wound that allows the bacteria found on the skin and the bacteria found in the mouth to infect the wound. The infection can then spread to the surrounding tissue next to the nail and cuticle.
Felon: This bacterial infection of the finger pad, caused by the same organisms that cause paronychia, is usually the result of a puncture wound. The wound allows the introduction of bacteria deep into the fingertip pad. Because the fingertip has multiple compartments, the infection is contained in this area.
Herpetic whitlow: The offending viral organism is the herpes simplex virus type I or II. This is the same virus that causes oral or genital herpes infections. People in certain occupations are more at risk for this infection.
Cellulitis: The most common causes of this bacterial infection are staphylococcal and streptococcal organisms. This infection is usually the result of an open wound that allows the bacteria to infect the local skin and tissue

Common causes of skin damage around the nail include:
• biting or chewing the nails
• clipping the nails too short
• manicures
• excessive exposure of the hands to moisture, including frequently sucking the finger.
• ingrown nails

Treatment

Treatments for paronychia will vary, depending on the severity and whether it is chronic or acute.
A person with mild, acute paronychia can try soaking the affected finger or toe in warm water three to four times a day. If symptoms do not improve, seek further treatment.
When a bacterial infection causes acute paronychia, a doctor may recommend an antibiotic, such as dicloxacillin or clindamycin.
Over-the-counter products aren’t usually recommended to treat nail infections since they don’t provide reliable results. Instead, your doctor may prescribe an oral antifungal medication, such as:
• Terbinafine (Lamisil)
• Itraconazole (Sporanox)
• Fluconazole (Diflucan)
• Griseofulvin (Gris-PEG)

Your doctor may prescribe other antifungal treatments, such as antifungal nail lacquer or topical solutions. These treatments are brushed onto the nail in the same way that you’d apply nail polish.

Prevention

The best away to avoid acute paronychia is to take good care of your nails.
• Avoid injuring your nails and fingertips.
• Don’t bite or pick your nails.
• Keep your nails trimmed and smooth.
• Avoid cutting nails too short.
• Don’t scrape or trim your cuticles, as this can injure the skin.
• Use clean nail clippers or scissors.
You can avoid chronic paronychia by keeping your hands dry and free from chemicals. Wear gloves when working with water or harsh chemicals.

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