Caleb Foster
Paronychia, commonly known as a nail infection, is a bacterial or fungal skin infection that develops around the nail. It can affect both fingernails and toenails. The infection can be acute or chronic, with symptoms ranging from red, swollen skin to an abnormal nail shape and discolouration. Treatment options vary depending on the severity and type of infection, with home remedies such as soaking the infected nail in warm water and applying lemon and salt, or medical interventions like antibiotics and antifungal medications.
| Characteristics | Values |
|---|---|
| Type of infection | Bacterial or fungal |
| Symptoms | Red, swollen skin around the nail that is painful, warm, and tender to the touch; nail becomes thick, discoloured, distorted, and brittle; the whole nail can break off |
| Treatment | Soaking the infected nail in warm water for 20 minutes a few times a day; topical antibacterial or antifungal ointment; antibiotics; antifungal creams, lotions, or oral medicines; incision and drainage method to drain pus |
| Prevention | Avoid biting or picking nails; trim nails and smooth the edges; avoid damaging cuticles; wear gloves when in contact with harsh detergents or chemicals; avoid injuring nails and the skin around them |
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What You'll Learn
Identify the type of nail infection
There are several types of nail infections, primarily categorized as bacterial or fungal. Paronychia is a common bacterial nail infection caused by bacteria entering broken skin near the cuticle and nail fold. It can be caused by trauma, irritation, or infection, and can affect both fingernails and toenails. Symptoms include inflammation, swelling, and pain around the nails, and it can be treated with antibiotics. Chronic paronychia is a more persistent form of the infection, often caused by irritants like detergents and chemicals, nail-biting, or underlying skin conditions.
Fungal nail infections, also known as mycotic nails, are characterized by changes in nail color, thickness, and texture. They usually develop slowly, starting at the edge of the nail and spreading to the rest of the nail. The nail may turn white, yellow, brown, or black, and become brittle, crumbly, and easy to break. These infections are more common in toenails, but can also affect fingernails. They can be treated with antifungal medications, and in severe cases, the nail may need to be removed.
Within fungal nail infections, there are several subtypes. Distal (lateral) subungual onychomycosis is the most common type, starting at the tip or sides of the nail. Proximal subungual onychomycosis originates from the proximal nail fold, with T. rubrum being the most common causative organism in the US. Superficial onychomycosis begins in the top layers of the nail and spreads deeper. Edonyx onychomycosis infects the interior of the nail plate, while totally dystrophic onychomycosis is the end stage of distal or proximal types, resulting in an extra thick and tall nail due to excess keratin. Yeast onychomycosis, often caused by Candida, affects fingernails more commonly than toenails and may indicate a weakened immune system. Lastly, fungal melanonychia is the least common type, caused by fungi that turn the nail brown or black.
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Visit a pharmacist or doctor
If you think you have a nail infection, it is important to visit a pharmacist or doctor to receive a proper diagnosis and treatment. A pharmacist can help you with a fungal nail infection. They will recommend the best treatment for you and may suggest an antifungal nail medicine that you brush onto the nail. You will need to use this regularly for a few months before you see any improvement, and you should keep using it until advised to stop by a healthcare professional.
If the infection is particularly stubborn, or if you have a weakened immune system, you may need to see a doctor. Before starting treatment, your doctor will take a sample of your nail to test what kind of infection you have. They may also need to take a blood test to check your liver is functioning properly. Your doctor may prescribe antifungal tablets or creams, gels, or pills. Antifungal pills like itraconazole and terbinafine work better than creams and gels, but they can affect your liver and interact with other medications, so your doctor will need to monitor you while you take them.
If the infection is deep and has been there a while, your doctor may want to remove all or part of your nail surgically or non-surgically. For non-surgical treatment, your doctor will put urea ointment on the infected nail surface and wrap the nail in plastic and tape. After about 10 days, they can remove the infected nail from the nail bed or cut away the diseased part. Surgical treatment involves loosening the skin around the nail with a special tool and removing the nail. This procedure is rarely done.
If you have diabetes and notice any changes to your toenails, see your doctor right away to prevent the problem from worsening.
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Surgical and non-surgical removal
In most cases, nail infections are not serious and can be treated at home. For example, paronychia, a bacterial or fungal skin infection, can be treated by soaking the affected finger or toe in warm water several times a day. However, if the infection is severe or does not improve, medical treatment may be necessary.
For fungal nail infections, a pharmacist may suggest an antifungal nail medicine that you brush onto the nail. You will need to use this regularly for a few months, and possibly for up to six months, before the infection clears. If pharmacy treatments do not work, your doctor may prescribe antifungal tablets.
In some cases, nail infections may require surgical removal of the infected nail. This is known as nail avulsion and is used when other treatments have failed. During a surgical nail avulsion, a dermatologist will remove as much of the nail as needed under local anaesthetic. Another type of nail avulsion is chemical avulsion, which involves applying a chemical called urea to the diseased nail and covering it with a bandage for 7 to 10 days, after which the treated nail is removed.
Ingrown toenails are a common type of nail infection that sometimes require surgical removal. During a partial or complete nail avulsion, a doctor will inject a numbing medicine into the toe before cutting away part or all of the toenail. If ingrown toenails recur, a doctor can perform permanent ingrown toenail removal by applying a chemical to kill the nail root.
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Antibiotics and antifungal treatments
Antibiotics are commonly used to treat bacterial nail infections, also known as paronychia. Paronychia can develop when bacteria enter the skin through cuts, broken skin, hangnails, or ingrown nails, leading to an infection around the cuticle and nail fold. Antibiotics work to kill the bacteria causing the infection. Oral antibiotics, such as amoxicillin, clavulanic acid (Augmentin), clindamycin (Cleocin), or cephalexin, are often prescribed for 5-7 days, in conjunction with warm water soaks. It is important to complete the entire course of antibiotics to prevent the infection from returning. In some cases, a small incision may be made to drain any pus that has built up around the nail bed. Antibiotic ointments or petroleum jelly may also be applied to the affected area to prevent bandage adhesion.
For fungal nail infections, antifungal treatments are necessary. Fungal nail infections cause the nail to become thickened, discoloured, and brittle. Antifungal tablets are typically taken for up to 6 months to treat the infection. However, it is important to note that antifungal tablets may not be suitable for individuals with liver or kidney disease, or for those who are pregnant or breastfeeding. In severe cases of fungal nail infections, the infected nail may need to be removed under local anaesthesia.
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Preventative measures
Keep your nails short and trim them regularly. This helps prevent fungi and other germs from collecting under your nails. Cut toenails straight across, keeping them shorter than the end of your toes. For fingernails, avoid creating tiny cracks or cuts in the nails or surrounding skin by biting nails or cuticles. Bacteria can enter through these small openings and cause an infection.
Sanitize your nail clippers and other nail grooming tools after each use. Wash the clippers with warm water and soap, then disinfect. If you have a nail infection, use a bleach and water solution. Otherwise, use 70% rubbing alcohol.
Protect your nails from trauma or irritation. Avoid frequent manicures or pedicures that can cause trauma to the nail bed or cuticle area. If you work with water or chemicals, wear protective gloves to prevent irritation and exposure to these substances, which can create an inviting environment for fungi.
Keep your nails and the surrounding skin clean and dry. Fungi thrive in warm, moist environments, so it's important to avoid walking barefoot in communal areas like locker rooms, gyms, and shared showers. When in these environments, wear shoes, flip-flops, or shower sandals. Additionally, if you're going to have damp or wet hands for an extended period, wear rubber gloves.
Be cautious when sharing personal items. Nail fungus can spread easily from person to person, so avoid sharing nail grooming tools, towels, shoes, and other personal items.
Finally, be vigilant about checking your nails for any signs of infection, such as thickening, splitting, discoloration, or lifting. If you notice any of these symptoms, seek treatment early to prevent the infection from worsening or spreading.
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Frequently asked questions
A nail infection can be bacterial or fungal. A bacterial nail infection (paronychia) can cause the nail to become inflamed, and can result from trauma, irritation, or infection. A fungal nail infection can cause the nail to become discoloured, thickened, brittle, distorted, and easy to break.
If you think you have a nail infection, you should speak to a pharmacist or doctor. They may recommend an antifungal treatment, such as a medicine that you brush onto the nail, or tablets. In some cases, a doctor may recommend removing the infected nail surgically or nonsurgically.
To prevent nail infections, it's important to keep your feet clean and dry, and to sanitise nail clippers. You should also treat athlete's foot immediately, as the fungi that cause it can spread to your toenails.
