Do you have a fingernail fold that looks like an inflammation of the skin around the nail? Does it bring discharge or pus and is painful to touch?
This is a very common hand infection often caused by bacterial (staph) or fungal (yeast), causing redness, pain, and swelling around the nail.
In this article, I rely on research studies on paronychia and my knowledge as a radiographer who sees these cases in radiology.
All references at the end of this article. Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: December, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️Anatomy of the nail complex
The nail complex is composed of modified cutaneous structures:
♦️Nail plate.
♦️Nail matrix.
♦️Nail bed.
♦️Proximal nail fold.
♦️Lateral nail folds
Source: Lomax 2016
Image source: Solish,2016
▶️What is paronychia?
Paronychia is inflammation or infection of the skin around the fingers or toes in one or more of the three nail folds.
Paronychial of fingers showing infection: Image source: Duhard,2014
Paronychia is an infection that may occur spontaneously or following trauma or manipulation (Dulski 2023)
There are two primary types of paronychia which are distinguished by the speed of onset, duration, and underlying causes
1️⃣Acute paronychia
♦️Develops rapidly over a few hours or days and typically lasts less than six weeks.
♦️In acute paronychia there is a rapid onset (over 2–5 days) of discomfort, redness, swelling and tenderness of one of the nail folds
♦️️ Usually results from a bacterial infection, most commonly Staphylococcus aureus. The bacteria enter through a break in the skin from minor trauma such as nail biting, picking at hangnails, aggressive manicuring, or an ingrown nail (Duhard,2014)
2️⃣Chronic paronychia
♦️Develops slowly and lasts for six weeks or longer. It often affects multiple fingers or toes and can recur.
♦️Usually results from primarily an inflammatory reaction (dermatitis) to irritants and chemicals, often complicated by secondary fungal infections (commonly Candida species
♦️Chronic paronychia is less common in the feet than in the hands (Lomax.2016)
(Duhard,2014)
Note: Patients with chronic paronychia that is unresponsive to standard treatment sometimes are investigated for unusual causes, such as malignancy (Lomax.2016)
▶️ What does paronychia look like?
If you noticed that one of your toes or fingernails are starting to fold, swell or bring pus? It could be paronychia.
Paronychial big too: Image source: Duhard,2014
It is one of the most common infections of the hand, Paronychia results from the disruption of the protective barrier between the nail and the nail fold, introducing bacteria and predisposing the area to infection.
▶️How can you be sure it’s paronychia?
Normally a medical professional will be able to examine your finger or toe through a simple physical examination and medical history, looking for characteristic symptoms like redness, swelling, and pain around the nail.
However, you may look for these key specific signs to help determine if your symptoms match paronychia.
✴️Location: The symptoms are specifically located in the skin that surrounds the edge or base of a fingernail or toenail.
✴️ Inflammation: The affected area is red, swollen, warm to the touch, and painful.
✴️Pus: A pus-filled blister or yellowish/greenish discoloration may be visible under the skin near the nail.
▶️What are the common causes of paronychia?
According to research studies these are the common causes of paronychia which are sometimes sudden and painful.
✴️Trauma/Injury
✴️Bacterial Infection such as polymicrobial after the protective nail barrier has been breached.
✴️Viral Infection
Causes of Chronic Paronychia (Long-Term Inflammation)
✴️Water Exposure
✴️Chemical Irritants include acids, alkalis, and other chemicals used by housekeepers, dishwashers, bartenders, florists, bakers, and swimmers (Leggit,2017)
✴️Fungal Infection
✴️Certain Medications:
✴️Underlying Conditions: Diabetes, HIV
Sometimes it is triggered by:
✴️Ingrown Toenails
✴️Manicures/Pedicures
✴️Occupation
✴️Habits
Rigopoulos,2008
▶️What are the red flags of paronychia?
Red flags of paronychia indicating that the infection may be spreading or that it is a more severe condition requiring immediate medical attention.
These signs suggest potential complications beyond a simple, localized infection and it may be spreading?
⚫Fever and Chills:
⚫The appearance of red streaks on the skin, extending from the affected area up the finger/toe or hand/foot towards the body, can indicate the infection is spreading through the lymphatic system
⚫ If the pain is severe, throbbing, and interfering with daily activities, or if the redness and swelling rapidly increase and extend beyond the immediate nail area, it could be a sign of a deeper infection like cellulitis
⚫ Pain when bending the affected digit may indicate the infection has spread to the underlying tendons (infectious tenosynovitis), which is a serious condition.
⚫General joint or muscle pain in the affected limb can also suggest a more widespread issue.
⚫A visible, pus-filled blister or abscess that does not improve with home care (like warm water soaks) may need to be professionally incised and drained.
⚫ If typical symptoms persist or worsen after several days of home treatment, or if chronic paronychia lasts for more than six weeks, medical evaluation is needed.
⚫While some nail changes can occur, significant detachment of the nail from the nail bed can be a red flag for a severe, long-standing infection or other underlying conditions
Sometimes when you have these symptoms it may be a sign that the infection is spreading and can turn to sepsis?
▶️What can be mistaken for paronychia?
Several conditions can be mistaken for paronychia, as they share similar symptoms like redness, swelling, and pain around the nail.
♦️Herpetic whitlow is a viral infection of the fingers caused by the herpes simplex virus (Lima,2021)
♦️Felon infection occurs within the closed-space compartments of the fingertip pulp. The swelling leads to intense throbbing pain (Nardi,2024)
♦️Cutaneous candidiasis / Fungal nail infections (Onychomycosis): can cause nail discoloration, thickening, and crumbling (koh,2023)
♦️Cellulitis is a bacterial skin and soft tissue infection which occurs when the physical skin barrier, the immune system and/or the circulatory system are impaired (Cranendonk , 2017)
Misdiagnosis is important to avoid, as treatment methods can vary significantly.so if you think you have any symptoms, it is important to get them checked for a proper diagnosis and better treatment option.
▶️What is the appropriate treatment for paronychia?
Treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors.
Appropriate treatment of diseases of the nail and the fingertip requires the correct diagnosis and a comprehensive understanding of the anatomy of the nail and surrounding area.
Case study: of an acute paronychial treatment option
➡️ A 46-year-old, right hand–dominant woman presents to the emergency room with pain in the right index finger.
➡️ It started 3 days prior and has progressively worsened.
➡️Examination reveals a tender, swollen, and erythematous eponychium.
➡️ A purulent collection seems to be present under the nailfold, but not under the nail plate itself, with no active drainage.
➡️The erythema does not extend proximal to the distal interphalangeal joint.
➡️ x-rays are normal except for some soft tissue swelling dorsally in the region described.
Source: Ritting,2012
➡️ In the absence of pus under the nail or in the nailfold, the usual treatment was oral anti-staphylococcal antibiotics with or without warm saline soaks.
Advocates of warm soaks believe the heat helps encourage spontaneous drainage of any occult pus
There are no studies that look specifically at the efficacy of warm soaks to support the above practice.
Here are some of the treatment options:
➡️Warm soaks with or without Burow solution or 1% acetic acid. Topical antibiotics are used with or without topical steroids when simple soaks do not relieve the inflammation (Leggit2017)
➡️If you have an abscess, it is normally drained. I have seen doctors using a hypodermic needle to a wide incision with a scalpel and drain.
➡️You may be given oral antibiotics but if adequate drainage is achieved, they are not necessary unless you have immunocompromised or a severe infection present.
Source: Leggit2017
Note: These treatment options are frequently recommended in the literature but not supported with high-level evidence.
Surgical management.
surgery is common practice in the presence of an obvious abscess.
➡️Using simple materials like 23G or 21G needle, cotton wool, chlorohexidine solution, methylated spirit and zinc oxide plaster, abscess in acute paronychia is drained by lifting the nail fold with the tip of the needle.
Ten cases of paronychia in 8 patients were drained with this method Ogunlusi,2005
Outcome:
Combination of the early drainage and antibiotics showed that all the patients were relieved of pain and could use their fingers normally within 2 days
Source: Ogunlusi,2005
When you have pus in the nail fold the drainage technique is simple and effective. Early drainage will prevent the occurrence of any form of complication.
Treatment may take weeks to months. You will be educated on how to look after your hands /foot to help reduce the recurrence of acute and chronic paronychia.
▶️Does paronychia go away on its own? Can I ignore paronychia?
Yes, mild cases of acute paronychia can often go away on their own with home treatment, such as:
🔵Soaking the finger or toe in warm water for about 20 minutes, a few times a day. Adding a little salt to the water can be helpful.
🔵Some people I see are advised to apply over-the-counter antibacterial ointment after soaking.
However, untreated infections can worsen, so it is important to see a doctor if the infection does not improve in a few days.
🔵If you have a high fever, or if the pain, swelling, or redness gets worse. An abscess may need professional drainage.
🔵You should not ignore paronychia (nail fold infection) as it can worsen, potentially leading to deeper infections, permanent nail damage, or spreading
🔵Ignoring it risks complications like bone infections (osteomyelitis) or tendon sheath infections (tenosynovitis), especially if you have a weakened immune system
▶️Should I go to A&E with paronychia?
You usually don’t need A&E for mild paronychia.But I have seen patients come to the Emergency Department (A&E) with a fever, spreading redness, severe pain, inability to move the joint, or suspect deep pus.
And when you have diabetes or a weakened immune system, these signal a potentially serious infection needing urgent drainage or antibiotics.
For minor cases, see your GP, they may recommend warm soaks and will advise you to see a doctor if there is no improvement in 1-2 days.
▶️Tips recommended to help you prevent recurrent paronychia
♦️ Apply moisturising lotion after hand washing.
♦️ Avoid chronic prolonged exposure to contact irritants and moisture.
♦️ Avoid nail trauma, biting, picking and manipulation and finger sucking.
♦️Avoid trimming cuticles or using cuticle removers.
♦️ Keep affected areas clean and dry.
♦️Keep nails short
These recommendations are based on expert opinion rather than clinical evidence (source: Rigopoulos,2008)
We have come to the end of this article; any questions or comments let’s meet in the comments section. Wishing you a quick recovery!🙋
📚Source:
Dulski A, Edwards CW. Paronychia. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Leggit JC. Acute and Chronic Paronychia. Am Fam Physician. 2017 Jul 1;96(1):44-51. PMID: 28671378.
Duhard É. Les paronychies [Paronychia]. Presse Med. 2014 Nov;43(11):1216-22. French. doi: 10.1016/j.lpm.2014.06.009. Epub 2014 Oct 23. PMID: 25441843.
Lomax A, Thornton J, Singh D. Toenail paronychia. Foot Ankle Surg. 2016 Dec;22(4):219-223. doi: 10.1016/j.fas.2015.09.003. Epub 2015 Sep 21. PMID: 27810017.
Ritting AW, O’Malley MP, Rodner CM. Acute paronychia. J Hand Surg Am. 2012 May;37(5):1068-70; quiz page 1070. doi: 10.1016/j.jhsa.2011.11.021. Epub 2012 Feb 3. PMID: 22305431.
Solish D, Weinberg T, Murray C. Surface Anatomy of the Nail for the Dermatologist. Journal of Cutaneous Medicine and Surgery. 2016;20(5):467-469. doi:10.1177/1203475416638043
Ogunlusi J.D, Oginni L.M, Ogunlusi O.O ,DAREJD simple technique of draining acute paronychia,Tech Hand Up Extrem Surg, 9 (2005), pp. 120-121
Lima RB, Borges MAP, Araújo LF, Martins CJ. Herpetic whitlow in a child with AIDS: the importance of Tzanck test in the diagnosis. An Bras Dermatol. 2021 Jul-Aug;96(4):477-481. doi: 10.1016/j.abd.2020.08.017. Epub 2021 May 18. PMID: 34016479; PMCID: PMC8245730.
Nardi NM, McDonald EJ, Syed HA, Schaefer TJ. Felon. 2024 Apr 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 28613683.
Koh XQ, Pan JY. Recalcitrant cutaneous fungal infections-A growing problem. Australas J Dermatol. 2023 Aug;64(3):315-321. doi: 10.1111/ajd.14115. Epub 2023 Jun 30. PMID: 37387447.
Cranendonk DR, Lavrijsen APM, Prins JM, Wiersinga WJ. Cellulitis: current insights into pathophysiology and clinical management. Neth J Med. 2017 Nov;75(9):366-378. PMID: 29219814.
Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46. PMID: 18297959.