Paronychia
A sore, inflamed nail fold. Acute: comes on over days, usually an infection after nail biting, a hangnail or a manicure. Chronic: lasts 6+ weeks, usually from wet hands, and behaves like dermatitis.
The paronychia ladder
Acute and chronic paronychia are treated differently, so follow the steps for your type. Most acute cases settle within days.
- Step 1 · Self-careAcute: warm soaksWarm water or diluted antiseptic, 10–15 minutes, 3–4 times a day for the first few days.
- Works
- Not tested in trials; settles many mild, early infections
- Cost
- Free, or a few dollars for antiseptic
- How long
- Expect improvement within 2 days
- Watch for
- A pus pocket, spreading redness, or no better in 2 days: see a GP.
Sitting with your finger in a mug is legitimate medical care.
- Step 2 · Self-careChronic: keep hands dryThe main treatment. Cotton-lined waterproof gloves for wet work, dry hands well, moisturise often.
- Works
- No trials, but every guideline’s foundation: without it, nothing else lasts
- Cost
- About $10–20 for gloves and a good hand cream
- How long
- Months: nail folds heal slowly
- Watch for
- Pushing back or cutting cuticles undoes the good work.
The cuticle is a seal, not a design flaw.
- Step 3 · PharmacyAcute: antiseptic ointment or paintFor a mild infection with no pus.
- Works
- Evidence weak (no good trials); may help mild cases
- Cost
- About $8–15
- How long
- A few days
- Watch for
- Skin irritation. It can’t fix a pus pocket.
No ointment can drain pus, however hopefully you apply it.
- Step 4 · PrescriptionChronic: strong steroid ointmentApplied to the nail fold to calm the dermatitis-like inflammation.
- Works
- Improved or cured about 6 in 10, vs 2 to 3 in 10 on antifungal tablets (one small trial)
- Cost
- Under the $25 PBS co-payment, about $15–25 a tube
- How long
- 2–4 weeks, then review
- Watch for
- Skin thinning with long use. Antifungals only if yeast is confirmed on testing.
Chronic paronychia is more eczema than infection. Antifungal roulette rarely wins.
- Step 5 · PrescriptionAcute: antibiotic tabletsSuch as cefalexin or flucloxacillin, if redness is spreading or it isn’t settling.
- Works
- Not well tested in trials; usually settles the infection within days
- Cost
- Under the $25 PBS co-payment, about $12–20
- How long
- Usually 5–7 days
- Watch for
- Nausea, diarrhoea, rash. Tell your doctor about any penicillin allergy.
Many mild cases don’t need them. Pus usually needs a drain, not just a tablet.
- Step 6 · ProcedureAcute: draining the pusA small cut under local anaesthetic, done by a doctor.
- Works
- No trials, but works for most: fast relief, often within hours; often all that’s needed
- Cost
- GP procedure, often bulk-billed or a gap of about $40–90
- How long
- One visit, then a few days of soaks and dressings
- Watch for
- The numbing needle stings. Never DIY it.
Bathroom surgery with a sewing needle: zero stars. Ten-minute GP procedure: five.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Antibiotic tablets for chronic paronychiaThe long-term type is inflammation, not infection, so antibiotics don’t fix it. Dry hands and steroid ointment do.
- Antifungal tablets for chronic paronychiaA trial found steroid cream worked better. Yeast is usually a bystander, not the culprit.
- DIY lancing with a needleCan push infection deeper. Doctors drain it with sterile kit and local anaesthetic for a reason.
- Tea tree oilNo trials for paronychia, and it can irritate already inflamed skin.
What you can do
- Don’t bite your nails, pick hangnails or cut your cuticles: the cuticle seals out germs.
- Moisturise your hands and nail folds often.
- Cut toenails straight across, and wear shoes with enough toe room.
- If you have diabetes, check your feet daily.
See your GP if
- Pain, swelling or pus not improving after 2 days of soaks
- You have diabetes, poor circulation or a weak immune system
- Small blisters around the nail (could be a cold-sore virus, which needs different treatment)
- A nail fold that hasn’t healed after 6 weeks, or keeps coming back
See a doctor the same day for red streaks up the hand or foot, fever, a very swollen fingertip pad, or pain on moving the finger.
Common questions
How do I treat a mild nail fold infection at home?
Soak in warm water, or a diluted antiseptic, for 10 to 15 minutes 3 to 4 times a day for the first few days. See your GP if it isn’t improving after 2 days.
Does paronychia need antibiotics?
Many mild cases don’t. Antibiotic tablets are used if redness is spreading or it isn’t settling, and a doctor can drain a pus pocket for quick relief.
What is chronic paronychia?
Nail fold inflammation lasting 6 weeks or more, usually in people whose hands are often wet. It behaves more like dermatitis than an infection, so keeping hands dry and a strong steroid ointment are the main treatments.
How long does paronychia last?
A mild nail fold infection usually improves within a few days to a week with warm soaks 3 to 4 times a day. Chronic paronychia, often linked to wet work, can last for weeks to months.
Should I pop or drain paronychia myself?
No. Squeezing or cutting it yourself can spread infection. If a pocket of pus forms, a GP can drain it safely with a small cut, which often gives quick relief.
When is a finger infection serious?
See a doctor urgently if redness spreads up the finger or hand, the whole finger swells, it hurts to bend, you have a fever, or you have diabetes or a weakened immune system.
Helpful resources
- NHS leaflet: ParonychiaPatient leaflet on causes, treatment and prevention, including keeping hands dry. Free, UK.
- NDSS: Daily foot care with diabetesSimple daily foot and toenail checks, and when to get help fast. Free, Australia.
Evidence and more information
- Healthdirect: Toenail infection
- JAAD: Steroid ointment vs antifungal tablets for chronic paronychia (2002)
maladywise.com/paronychia/