Breaking a nail is undoubtedly annoying—and often quite painful. While it might seem like the worst thing that could happen to your mani, paronychia may have it beat. Now you’re probably asking, “paron-who?” “Paronychia is an infection of the tissue folds around the nail that is typically caused by irritation or trauma, like cuticle damage, a hangnail, or excess exposure to moisture (such as someone whose hands are constantly wet from dishwashing, for example),” explains board-certified facial plastic surgeon Jaimie DeRosa, MD. “The condition affects more than 200,000 people a year in the United States alone.”
Paronychia is most commonly caused by bacteria, usually Staphylococcus aureus, as a result of continuous irritation of the skin, hands, and feet being constantly wet and warm. Sometimes it’s also caused by cuticle damage due to picking or biting (the mouth is full of bacteria that can cause this infection), explains DeRosa. “A good example would be someone skiing for multiple days wearing warm, wet ski gloves and developing paronychia as a result,” she says.
Board-certified dermatologist Rebecca Marcus, MD, adds that trauma to the protective barrier around the nail (the cuticle) can provide an entryway for microorganisms. “Trauma may result from physical injury caused by cutting cuticles, or it may be due to cracks and fissures in the skin that have occurred for other reasons such as dry skin or irritant dermatitis,” she says.
What Is Paronychia?
“Paronychia is a soft tissue infection that occurs around the nails on the fingers or toes,” says Marcus. “It can either be acute, in which case it is most often caused by staph bacteria, or chronic, in which case it is often caused by fungus. Paronychia manifests as swelling, tenderness, erythema (redness), and sometimes pus in the skin around the nail. It is usually tender and sometimes warm to the touch.”
Symptoms of paronychia will typically develop over hours to several days, sometimes even longer. “They will first become evident in the area where the skin meets the nail at the nailfold,” DeRosa says. “It will manifest as pain, swelling, and tenderness around the nail. The skin may also be warm to touch due to inflammation. As the paronychia worsens, you may see pus developing under the skin, eventually forming an abscess if untreated and allowed to progress.”
The good news? “Most paronychia can be treated at home without visiting your doctor,” DeRosa says. Ahead, DeRosa and Marcus walk us through the best ways to treat paronychia at home.
Fill a bowl or basin with warm tap water. (Use a bowl for fingers and a bigger basin for toes.) The water should be warm, but not so hot to cause pain or discomfort. “If you have broken skin then add salt or a saline solution,” DeRosa says. “Use a few tablespoons of table salt, Epsom salt, or saline solution. Warm water alone will also work in the early stages of the condition when you have just red, swollen skin. Soak the affected toe or finger for about 20 minutes at a time three to four times per day. If the water becomes cool before the time is up, then add more hot water to keep it warm.”
Alternatively, Marcus says you can do a warm soak to treat acute paronychia by wrapping the affected area in a washcloth that is saturated with warm water and keeping it in place for 10 minutes.
“After soaking, make sure that you thoroughly dry the affected area,” DeRosa says. “You can also apply petroleum jelly and cover it with a bandage if you have broken skin or will be working with your hands.”
Moisture is not your friend when it comes to paronychia. “Chronic paronychia, which is often caused by fungus, may be worsened by moisture, so in this case, the affected area should be kept dry,” Marcus says.
“Keep your hands dry between soaking sessions and avoid biting your nails or sucking on your fingers" so you don't re-introduce infection, DeRosa says. She advises washing your skin regularly with soapy water that is warm, "but not so hot that it's uncomfortable.”
Mind Your Cuticles
You can decrease the chances of developing paronychia in the first place by avoiding trauma to the cuticle. “When getting a manicure, it’s best to gently push cuticles back rather than cutting them,” Marcus says. “All tools should be sterile. Minimize chances of fissures and cracks in the skin around the nails by keeping hands well hydrated and moisturized.” And avoid biting your nails and cuticles.
Protect Your Hands
“When working with cleaners, chemicals, or detergents, use rubber gloves to protect your hands,” DeRosa says. “It is even better if you use cotton inserts for the gloves to help keep your hands dry, too.”
Normally, it takes about 24 to 36 hours to see a marked improvement in the symptoms of paronychia after your at-home treatment. The first sign that the condition is improving is less pain, as well as fading redness.
“Do not be alarmed if it takes some time for the symptoms to improve as the body’s response may not be noticed immediately,” DeRosa says. “However, if you see that symptoms are not improving within this timeframe or symptoms are reappearing after initially getting better, it’s probably time to seek professional medical help.”
Contact a medical professional to see if you need antibiotics if your paronychia hasn’t started improving within 36 hours, or if it’s getting worse. “If an abscess is present, it’s best to see a dermatologist to assess, it as it may need to be surgically drained,” Marcus says. If you notice that swelling and redness are increasing quickly, get professional help immediately—and do not wait.