Paronychia
Inflammation of the skin fold around a fingernail or toenail. Acute paronychia comes on over hours to days, usually as a bacterial infection a few days after nail biting, picking a hangnail, a manicure or an ingrown toenail. Chronic paronychia lasts 6 weeks or more, usually in people whose hands are often wet, and behaves more like dermatitis than an infection.
Treatment options
Ratings show how strong the research is.
- Strong evidenceAcute: draining pusIf a pus pocket forms, a doctor can drain it with a small cut under local anaesthetic. This gives quick relief.
- Moderate evidenceAcute: antibiotic tabletsSuch as cefalexin or flucloxacillin, if redness is spreading or it isn’t settling. Many mild cases don’t need them.
- Moderate evidenceChronic: keep hands dryThe most important step. Wear cotton-lined waterproof gloves for wet work, and dry hands well.
- Moderate evidenceChronic: steroid ointmentA strong steroid ointment on the nail fold for 2 to 4 weeks. Worked better than antifungal treatment in a trial.
- Limited evidenceAcute: warm soaksSoak in warm water, or a diluted antiseptic, for 10 to 15 minutes 3 to 4 times a day for the first few days.
- Limited evidenceAcute: antiseptic or antibiotic creamMay help a mild infection without pus.
- Limited evidenceChronic: antifungal treatmentOnly if a yeast infection is confirmed on testing.
- Not recommendedCutting it open yourselfRisks spreading infection. See a doctor instead.
What you can do
- Don’t bite your nails, pick hangnails or push back 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.
Evidence and more information
maladywise.com/paronychia/