How can you address a nail infection?

Hand doctor Sydney 

Infections of the nail bed are very common. Medically known as paronychia, this condition can affect either fingernails or toenails. It usually gets better quickly, but sometimes a minor surgical treatment may be needed. 

What causes paronychia?

Paronychia starts when bacteria enter a small cut or break in the skin around the cuticle (at the base of the nail) or the nail fold (at the sides of the nail). Over the course of the next few hours to days, various signs of infection will develop, including redness, warmth, swelling, and pain or tenderness. In some cases, a collection of pus may develop.

 

Although anyone can develop paronychia, certain factors make it more likely. People are more likely to develop a nail infection if they:

 

• Work with irritants (such as chemicals), particularly if they don’t consistently wear protective gloves while working
• Frequently have their hands wet (such as working as a dishwasher or bartender)
• Have a chronic skin condition
• Get frequent manicures or pedicures
• Bite, pick, or chew their nails 
• Experience ingrown nails or hangnails 

 

All of these make it more likely that the skin around the nail will crack or break, which then allows bacteria to enter.

Does paronychia get better on its own?

In some cases, paronychia will get better on its own. However, if it’s left untreated, the infection can affect how the nail grows, which is known as chronic paronychia. Treatment can help to reduce the chances that this will occur.

 

The first line of treatment is to soak the affected area in warm water for 15 minutes a few times a day. Dry the area thoroughly after each soak. This helps pus to drain out of the area, which helps the infection to clear up more quickly. Some providers recommend soaking in a solution of 1% vinegar or aluminum acetate (Burow’s solution), instead of plain water.

 

If symptoms are not improving after a day or two of this home remedy, then you should see your doctor. They might prescribe topical antibiotics, which will help to clear up the infection. They may also recommend a topical steroid to decrease inflammation. 

 

There might also be an abscess (a collection of pus) that has developed in the area. It’s very difficult for the body to clear up an abscess on its own, even with antibiotics. It’s often necessary for a doctor to drain the abscess, which involves making a small puncture or cut in the skin in order to allow the pus to drain out. This is a very minor surgical procedure. The cut will not be stitched closed, because this would prevent the pus from draining out. You’ll need to ensure that you keep the area clean and bandaged while it heals.

 

Occasionally, it’s necessary to do a deeper incision in order to effectively drain the abscess. This requires local anesthesia in order to numb the finger or toe. Part of the nail itself may also need to be removed in order to allow the pus beneath to drain out. As long as the nail bed has not been damaged too much, the nail will grow back over time.

What can you do about chronic paronychia?

In many cases, paronychia develops quickly, and then gets better relatively quickly as well. However, there are also cases where the infection lasts for a long period of time. This usually occurs in people who have diabetes or other conditions that reduce circulation to the hands and feet. This is known as chronic paronychia. It can also occur because of chronic exposure to irritants or allergens, which creates inflammation around the nail. One or more nails may be affected.

 

Chronic paronychia causes nails to be particularly thick and brittle. They often have a yellow or green color, and may also develop unusual ridges or waves. One or more nails may be affected.

 

In people with chronic paronychia, there is often infection of nail bed by a fungus (yeast) known as candida. Researchers believe that the fungus is not the cause of chronic paronychia, but rather is able to grow in the area around the nail because of the chronic inflammation caused by the condition.

 

The first line of treatment for chronic paronychia is to calm the inflammation with topical steroids (a strong anti-inflammatory medication) and/or antifungal medications. In some cases, an oral antifungal medication is given. It will take several weeks of treatment to see results. It’s also crucial to remove sources of irritation, including wearing waterproof gloves when the hands will be wet for a long period of time or when working with chemicals (such as cleaning solutions).

 

If these medications aren’t effective, then a surgical procedure may be recommended. This involves removing a crescent of skin at the base of the nail. Often, the nail itself is removed at the same time. Over time, new, healthier skin will grow in the area, and a new nail will also grow. This procedure cures chronic paronychia in about 70% of people who undergo it.

Hand doctor Sydney

If you’re experiencing an infection of your nail and home treatment hasn’t worked within the first day or two, or if you have a nail that’s showing abnormal growth patterns, the first step is to visit your primary care doctor. Medications can often help to address the issue. If this has not been effective, then a surgical procedure may be considered. 

 

Dr. Sungaran is an expert in all types of surgical procedures of the hand, including surgical options for paronychia. If you’re at the point of considering surgery, or wondering whether this may be an effective option for you, please schedule a consultation here in our office. Simply contact our office to book your appointment.