Paronychia: What It Is, How to Treat It, and Prevention
Paronychia is a pus-filled infection or abscess that develops around the nail of a finger or toe. It is most commonly caused by the bacteria Staphylococcus aureus (S. aureus) or Herpes. Paronychia is a common skin condition that can be persistent and prone to recurrence if not treated and prevented properly.
Causes of Paronychia on Hands and Feet
Paronychia is an infection of the nail folds of the fingers or toes, caused by the Streptococcus bacteria and Staphylococcus aureus. When the skin is broken or scratched, especially in people who sweat a lot, bacteria can easily enter through these breaks in the skin, multiply and grow, causing infection.
Because nail injuries are usually minor, they are often overlooked by patients and left untreated. Typically, paronychia is rarely treated in its early stages, and by the time it progresses to a more severe stage, the paronychia has already become purulent, and patients will then seek medical attention and treatment. At this point, patients may experience complications from paronychia if it is not treated promptly.
Progression of Paronychia on the Fingers and Toes
Paronychia of the fingers or toes typically progresses through three stages:
Stage 1: Occurs within the first 1-3 days, when swelling, redness, itching, and later pain and discomfort appear at the tip of the finger or toe. This may also cause stiffness or difficulty moving the affected finger or toe.
Stage 2: From day 4-7, the infected inflammation begins to spread around the finger or toe, causing pain, tightness, and throbbing with each pulse. At this stage, the inflammation can cause the patient to develop a mild fever.
Stage 3: Pus begins to accumulate at the initially swollen and red area. If not treated promptly and properly, paronychia can lead to complications such as osteomyelitis, tenosynovitis, arthritis, or sepsis.
However, in the case of paronychia caused by Herpes, the incubation period is approximately 2-20 days. General symptoms such as fever and fatigue may appear as the first signs of the disease, but this is less common. More common symptoms include a burning, stinging sensation on the affected finger caused by the Herpes virus. The affected finger will then become red and swollen, with 1-3mm blisters appearing on the reddened skin, persisting for 7-10 days. The blisters may ulcerate and rupture, often containing a clear, cloudy, or bloody fluid.
Following the initial infection, the Herpes virus from the affected finger enters the nerve endings in the skin, travels to peripheral nerve ganglia and Schwann cells, and remains dormant there for an extended period.
When conditions are favorable, such as a weakened immune system, psychological trauma, exposure to X-rays, ultraviolet radiation, or laser, the virus reactivates, moves to the skin, and causes secondary Herpes infections. Typically, the clinical symptoms of a primary Herpes infection are the most severe, while secondary infections are milder and of shorter duration.
Differentiating Paronychia from Other Skin Conditions
Paronychia should be distinguished from other nail fold skin conditions on the fingers and toes, such as:
Dyshidrosis: This condition often causes itching and mild swelling but rarely causes pain.
Acute paronychia: This condition causes swelling, pain, and may lead to pus formation.
Paronychia caused by melanoma: This condition usually affects the thumb, is black in color, causes swelling, and may result in nail loss.
Generally, paronychia caused by the Herpes virus develops within 2-20 days. It is important to recognize the specific symptoms of paronychia caused by the Herpes virus to differentiate it from the skin conditions mentioned above and ensure proper treatment. Specifically:
When infected, the tip of the finger experiences a sharp, burning pain.
Subsequently, the affected area begins to swell, redden, and blisters form on the reddened skin. This stage can last for 7-10 days.
Ruptured blisters reveal a clear, cloudy, or bloody fluid.
After causing the infection, the Herpes virus enters the sensory nerve endings in the skin and travels to Schwann cells and peripheral nerve ganglia, where it remains dormant until favorable conditions arise.
Complications of Paronychia
Within the first 7-10 days after the onset of paronychia, the affected area may progress to a stage where it becomes purulent. At this point, if not treated promptly by lancing to drain the pus, or if the lancing is not deep enough to allow all the pus to drain out, paronychia can lead to complications:
Osteomyelitis
Arthritis
Tenosynovitis of the joint
Sepsis
With the complications listed above, paronychia can cause inflammation of the bone, leading to swelling, pain, redness, and eventually bone loss. The doctor will order an X-ray to examine the affected area and check for complications.
The X-ray image will show inflammation of the bone with bone fragments. To treat this, the doctor must perform surgery to remove the bone. This complication can lead to the loss of a bone segment, affecting the overall function of the hand.
What to Do When You Have Paronychia on Your Hand
When experiencing paronychia on the fingers or toes, do the following:
Maintain hygiene of the affected area by washing it with diluted potassium permanganate solution. After cleaning, apply an antibiotic ointment such as Fucidin, Foban, or Bactroban to prevent the spread of infection. Note that the ointment should be applied as directed by a medical professional.
If paronychia becomes purulent, seek immediate medical attention for proper treatment. The doctor will make an incision to drain the pus and may also prescribe antibiotics.
If the affected area remains swollen, painful, or unresponsive to treatment after following the above steps, the doctor may order an X-ray to determine if the paronychia has caused any complications.
Prevention of Paronychia on the Fingers and Toes
To prevent paronychia on the fingers and toes, it is important to:
Maintain regular hygiene by washing your hands and feet daily.
Avoid soaking your hands or feet in water for extended periods.
Wear shoes and socks that fit well and protect your feet from blisters.
Avoid walking barefoot, especially in sandy areas.
Avoid cutting your fingernails and toenails too short or too deep, especially in the corners of the nail bed. Keep your nails longer than the skin to prevent the corners from digging into the skin and causing paronychia.
When paronychia occurs on the fingers or toes, it is important to prevent the infection from spreading by maintaining hygiene and applying antibiotics. If the affected area becomes purulent, seek immediate medical attention to have the pus drained and receive appropriate treatment to prevent further complications.
Home Remedies for Paronychia
If you have paronychia, you can choose from four effective home remedies:
7.1 Warm Water Soak
Soaking in warm water can help relieve pain associated with paronychia. You can add salt or Epsom salt to the water for better pain relief. A higher salt concentration helps reduce swelling caused by paronychia.
How to do it
Fill a container with enough warm water to submerge the affected area. Soak for about 15 minutes.
Repeat the warm water soak whenever the pain recurs.
After the warm water soak, wrap an ice pack around the affected area to prevent the infection from spreading.
7.2 Antibacterial Soap Soak
If the pustules have already ruptured, you can add regular or antibacterial soap to warm water and soak the affected finger.
Research suggests that regular soap is as effective as antibacterial soap in protecting the body from bacteria and infections. Adding soap to the water helps prevent the spread of paronychia by diluting the discharge.
7.3 Ice Pack Application
The extreme cold will numb the nerves around the affected area and provide pain relief. Ice also slows down blood flow to the infected area, reducing inflammation and swelling (if any). You can buy ice packs from a pharmacy or wrap ice cubes in a towel and gently apply the ice pack to the affected area.
7.4 Vinegar Soak
This is a simple yet highly effective home remedy for paronychia. For this remedy, you can use vinegar or apple cider vinegar diluted with water in a 1:4 ratio of vinegar to water. Soak your feet or hands for 15-20 minutes, then pat dry. Repeat this remedy 2-3 times a day for best results.
7.5 Epsom Salt Soak
Epsom salt is another name for the inorganic salt magnesium sulfate. This type of salt is widely used in beauty and health care. Soak in Epsom salt if you have paronychia because this type of salt is effective in reducing pain and infection.
Epsom salt soak – the best home remedy for paronychia, used by many people
How to do it:
Mix 2 tablespoons of Epsom salt per liter of water.
Use 1-2 liters of warm water.
Soak for 20-25 minutes, then pat dry with a clean towel. Repeat 2-4 times a day.
Prevention of Paronychia
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