Nail Fold Infection (Paronychia)

Paronychia is inflammation of the skin fold around a nail. The acute form is a bacterial infection that comes on over a day or two, often after a hangnail, nail biting or a manicure. The chronic form lasts more than 6 weeks and is mainly an irritant problem of hands that are often wet.

Acute paronychia usually settles quickly once pus is released. Chronic paronychia is slower: the cuticle has been lost, water and irritants get under the fold, and recovery depends more on protecting the hands than on any medicine.

Symptoms

• Red, swollen, tender skin at the side or base of one nail
• Throbbing pain and a visible yellow pocket of pus in the acute form
• Puffy, boggy nail folds on several fingers with no cuticle in the chronic form
• Ridged, discoloured or distorted nail growing out after months of inflammation
• Pain on pressing the nail fold
• Occasionally small blisters, which suggest herpes rather than bacteria

Causes and risk factors

Acute paronychia follows a break in the skin seal: biting, picking, an ingrowing nail, a splinter or aggressive cuticle trimming. Staphylococcus aureus is the usual organism. Chronic paronychia affects cleaners, cooks, bar staff, nurses, hairdressers and anyone with constantly damp hands; irritants and sometimes Candida yeast keep the inflammation going. Diabetes, some acne and cancer medicines, and thumb sucking in children are other contributors.

How it is diagnosed

• Clinical examination: The appearance and time course are usually enough. The doctor checks whether pus has tracked under the nail or into the fingertip pulp.
• Swab of pus: Taken if the infection is severe, recurrent or not responding, to identify the organism and its antibiotic sensitivity.
• X-ray of the finger: Only for a long-standing or deep infection, to make sure the bone underneath is not involved.
• Biopsy: Rarely, when a single persistent inflamed nail fold does not behave as expected, to exclude a tumour or an inflammatory skin disease.

Treatment options

• Warm soaks: Several times a day in early acute paronychia before pus has formed. Many mild cases settle with this alone.
• Drainage: Once pus has collected, a small release under local anaesthetic gives rapid relief. Part of the nail is removed only if pus lies beneath it.
• Antibiotics: Used when there is spreading redness, diabetes or a weakened immune system. They do not replace drainage of an abscess.
• Topical steroid and barrier care: The main treatment for chronic paronychia, applied to the folds for several weeks, together with keeping hands dry.
• Glove routine: Cotton liners under waterproof gloves for wet work, no cuticle cutting and no nail biting until the seal has regrown.

When it is urgent

Get same-day local care if redness spreads along the finger or hand, if the fingertip pad becomes tense and very painful, if you cannot bend the finger without severe pain, or if you have fever or red streaks up the arm. These suggest a deeper hand infection, which can damage tendons and needs prompt treatment.

Travelling to Türkiye for treatment

Paronychia is not a reason to travel: the acute form needs care within a day or two where you are, and the chronic form improves with months of hand protection at home. If you are already visiting for other treatment, a dermatologist can confirm the diagnosis and set out a plan during the same trip.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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