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Paronychia: a pain in the nail

Paronychia: a pain in the nail

Discover the causes, symptoms, and treatments for Paronychia, a common cuticle infection that can cause pain, swelling, and abscess
Cuticle infection - paronychia
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“Pus-filled blisters around my nails have been a norm for me. Working in the metal recycling industry meant callous hands more prone to infections as it requires me to sift through scraps for hours at a time,” says Ziaulla, 48, from Bengaluru. Despite being meticulous about hygiene, he frequently contracts cuticle infection known as paronychia. As explained by Dr Sunil Kumar Prabhu, consultant dermatologist and aesthetic physician at Aster RV Hospital, Bengaluru, “Paronychia is a condition that affects the skin around your cuticles which is a layer of clear skin located along the bottom edge of the finger or toe.” 

Causes of paronychia

Paronychia can be either acute or chronic. “Acute paronychia is typically brought on by a bacterial infection, with common culprits being Staphylococcus aureus, Streptococcus pyogenes, or Pseudomonas pyocyanea,” says Dr Alpana Mohta, consultant dermatologist and senior resident at Sardar Patel Medical College, Rajasthan. A 2008 study published in the American family physician journal revealed that acute paronychia can also be caused by viral infections like herpes simplex or fungal infections like Candida albicans. It may also result from physical trauma, such as nail biting or picking. 

In contrast, the main cause of chronic paronychia is nail fold dermatitis (nail abnormalities causing folds in nails, inflammation and swelling). Additionally, repeated exposure to irritants and allergens can also trigger the condition. 

The study also reports that the condition is more prevalent among laundry workers, cooks, dishwashers, bartenders, chefs, fishmongers, nurses, and swimmers. “People with poor circulation, diabetes, or those who are immune suppressed are also at higher risk of developing paronychia,” says Dr Mohta. 

Identifying symptoms of paronychia 

Dr Prabhu lists the common symptoms.

  • Redness of the skin around the nail
  • Tenderness 
  • Abscess 
  • Changes in nail shape, colour, or texture 
  • Nail detachment 

The symptoms also depend on whether it is acute or chronic. Dr Mohta says, “Acute paronychia develops rapidly over a few hours and usually affects a single nail fold. The affected area may become red, swollen, and painful.” Pus appears under the cuticle, and the nail plate lifts. In some cases, multiple tender vesicles are also observed. 

 Chronic paronychia is a gradual process that starts in the proximal nail fold and often spreads laterally and to several other fingers. The affected nail fold is usually swollen, and the nail plate is lifted off , which allows the entry of irritants and microorganisms. Ziaulla says, “Sometimes the skin around the cuticle and a quarter of the finger becomes red. My fifth finger’s nail plate had also become distorted.” 

Precautionary measures

Dr Mohta lists out ways to keep the cuticles and nails healthy and prevent paronychia. 

  • Maintain good hand hygiene by washing them regularly and drying them thoroughly. 
  • Avoid biting your nails or picking at the skin around your nails. 
  • Keep your nails trimmed but avoid cutting them too short. 
  • Wear protective gloves if your job involves prolonged exposure to water or chemicals. 
  • Avoid exposing your hands to excessively cold or wet conditions for extended periods. 
  • Treat any cuts or breaks in the skin around your nails promptly with an antiseptic. 
  • If you have a chronic condition such as diabetes, work with your healthcare provider to manage your condition and reduce the risk of infections. 
  • Apply a good moisturising hand cream right after washing your hands. 

Read more: Beyond manicures: the role of cuticle care 

Treatment at home

“Mild forms of paronychia can usually be treated at home. Your doctor can prescribe an antibiotic or antifungal medication for more serious cases,” says Dr Prabhu. 

  1. Apply warm compresses or soak the finger in warm, soapy water for 10 to 20 minutes, at least twice a day. 
  2. Apply antibiotic or antifungal cream. 
  3. Keep the infected area covered with a sterile bandage.

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