Fingers and toes of patient with moderate/grade 2 Paronychia during EGFRI-treatment. Image provided with courtesy of Prof. Dr. Siegfried Segaert (University Hospital Leuven, Leuven, Belgium). © 2009 All rights reserved.

Paronychia is an infection that usually affects the skin found around the fingernails and the toenails. This infection is caused mostly by a bacteria or a type of yeast that is known as candida. Sometimes, the disease can be produced as a result of the combination of both bacteria and yeast.

There are two different types of paronychia and the cause of the infection as well as how fast the onset of the disease comes on determines the kind of paronychia that affects the patient. Some can come in slowly and lasts for some weeks while some can come in gradually and continue for some days.

The symptoms of paronychia are very easy to detect and spot. It is also very easy to treat, and you can also successfully manage it without causing any permanent damage to your skin and likewise to your nails. If it is not treated, it can cause the loss of your nails or your skin or even both if care is not taken

The two different types are acute and chronic paronychia. Acute paronychia usually occurs around the fingernails, and the onset is always very sudden. It occurs as a result of the damage to the skin, i.e. the cuticle or the nail fold. Most times it is caused due to biting, picking, manicures, hangnails, and any other physical trauma that can occur to the nail fold.

Once this occurs, pathogens such as bacteria and yeast to infest and inoculate the nail fold hence resulting in an infection. Staphylococcus and enterococcus bacteria are the common causative agents for acute paronychia.

However, for chronic paronychia, the infection can occur on your fingernails as well as your toenails. Unlike acute paronychia, the disease doesn’t come on suddenly. Instead, it follows a gradual process.

Most times, chronic paronychia occurs for several weeks, and if poorly treated at first, it can come back again. This infection is typically as a result of the combination of both yeast and bacteria. This means that for the disease to become chronic, two causative agents are at work.

These causative agents include candida (yeast) and bacteria. People who contact this infection are those who most times are working with water. People who work in water such as divers, and so on are those who have a higher risk of contracting this infection.

When you always have a wet skin and you are involved in soaking in water frequently, it will disrupt the healthy, natural barrier of the cuticle also known as the nail folds. Once this occurs, it will cause yeast and bacteria to grow on the skin(this is because bacteria and yeast always thrive in a wet environment). These agents will eventually get to underneath the surface and cause an infection to occur.

What then are the symptoms you would experience when having paronychia?

The symptoms of both acute and chronic paronychia are very similar. The only thing that differentiates them is how quickly their onset is and how long the infection stays.

For acute paronychia, you will notice that the infection begins so swiftly and suddenly and it usually ends within a few days while for chronic paronychia, the infection starts slowly and gradually, and the infection can last for several weeks.

Generally, anyone who has either acute or chronic paronychia will have the following symptoms:

  • Redness that is found just around the skin or around the nail fold
  • You will experience tenderness around the skin around or beneath the nail fold.
  • You may experience blisters as well which are filled with pus.
  • There will be changes in the shape, colour, texture and strength of your nail.
  • Your nail might just begin to detach itself.

Causes of paronychia


Although there are usually multiple causes of paronychia, there always trace back to the two fundamental causes which are majorly bacteria and to a lesser extent yeast. Sometimes, it could be as a result of the combination of the two agents.

For acute paronychia, it’s the most common cause is a mild trauma which could be direct or indirect to the nail fold or to the cuticle.

The wound can arise from regular events such as dishwashing, an injury from a pointed object (probably from a splinter or a thorn), nail-biting otherwise known scientifically as onychophagia, picking or biting at a hangnail, finger sucking, problems arising from a poorly done manicure, or problems resulting from the application of an artificial nail.

This, therefore, causes the inoculation and growth of bacteria and it can also lead to subsequent infection. The common bacteria that is responsible for this infection is Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas pyocyanea, and Proteus vulgaris. In some patients, it may occur as a result of the exposure to oral flora as well as other anaerobic gram-negative bacteria.

For chronic paronychia, the underlying agent of this infection is yeast most especially candida. Sometimes, however, bacteria might also be seen as the causative agent.

Yeast is an agent that thrives well in wet and moist environments, and hence this infection would happen to you if you are found continuously putting your hands and feet in water almost all the time. Also, you may develop chronic inflammation of the cuticle alongside chronic paronychia.


Doctors mostly diagnose paronychia after they have observed the infected finger or toe. He may also decide to collect pus from the infected area in order to know the cause of the infection. Pus is usually obtained from the infected area in a situation where the treatment offered doesn’t seem to have any effect.

The pus taken from the infected area is then taken to the lab for proper diagnosis, and once the doctor knows the causative agent, it would be very easy to prescribe an effective treatment for the infection.


For mild cases of acute paronychia, home treatments have been observed to help in treating the infection. While you can decide to treat acute paronychia at home, it is more difficult to treat chronic paronychia, and it can’t be treated at home.

If you are having acute paronychia with a collection of pus under the skin, you are encouraged to soak the infected area inside warm water as many times as possible during the day, and afterwards, you must dry it thoroughly. This procedure will encourage the collection of pus around the area to drain on its own

If there is any artificial attached nail to it, ensure that you remove the nail before you begin treatment. Ensure you don’t remove any part of the nail. You might be prescribed some antibiotics if your doctor notices that the infection is more severe than it seems or if it probably hasn’t been responding to home treatment.

For speedy healing and quick relief from discomfort, you may need to drain the fluid out of the abscesses and blisters. However, this procedure should be done by the doctor in order to avoid the spread of the infection to other parts of the finger.

While draining the pus from the infected finger, some can be collected for diagnosis in order to know the exact pathogen that is the cause of the infection.

However, for chronic paronychia, treatments must be carried out at the hospital or clinic, and this is because it is tricky and more difficult to treat. You will be prescribed with an antifungal medication as well as you must keep the infected finger or toe dry.

In a severe case of chronic paronychia, you may need to undergo a surgical procedure that will help in removing the infected part of the nail. Other drugs and treatments which helps in reducing or blocking out inflammations as well will be prescribed.


In order to prevent paronychia, either acute or chronic, you must always practice good hygiene. Ensure that you always keep your hands and toes clean in order to avoid bacteria or any other pathogen from getting into your nails or under your skin.

You must also avoid trauma that is caused by biting of nails, nail picking, pedicure and manicure techniques in order to avoid infections that comes along with them. For you to prevent a chronic paronychia infection, make sure that you reduce your exposure to water and wet environments. Also, make sure that your hands and feet are dry most of the time as bacteria and yeast always love to stay in wet environments.

Treatment outlook

If you have a mild case of acute paronychia and you successfully treated it, it is very unlikely for the infection to return. Even if you let it go for some time, but you get medical treatment as soon as you can, the disease will still likely not return.

However, for chronic paronychia, the infection will most likely last for weeks, or even some may run into months hence making it more difficult to manage. In other words, the longer you stay to treat it, the more difficult it becomes to handle. This, therefore, makes early treatment the best option and route you should take.