Treatments for Nail Problems – Paronychia

The nail disease paronychia [par’onikeea] (commonly misidentified as a synonym for whitlow or felon) is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail. The infection can start suddenly (acute paronychia) or gradually (chronic paronychia).

Dr. Rob Hicks writes on the BBC web: The cuticle acts as a protective seal but if it’s damaged in any way bacteria can enter the skin and cause infection. These infections can be extremely painful as the skin becomes inflamed, hot, red and throbs continually.[5]Pus is usually present, along with gradual thickening and browning discoloration of the nail plate.If a large amount of pus has collected, then it may be necessary to see your doctor who will lance open infection in the skin to release it.

Acute paronychia is usually caused by bacteria. This is often treated with antibiotics, sometimes as a cream, other times orally. Chronic paronychia is most often caused by a yeast infection of the soft tissues around the nail but can also be traced to a bacterial infection. If the infection goes on and on then a fungal infection isoften the cause and this needs anti-fungal cream or paint to treat it.[5]Whitlows are common, especially for people who have to repeatedly wash their hands. Excess water weakens the seal, while soaps and detergents remove the protective skin oils leaving the skin dry and more liable to split. Most often, trauma to the cuticle allows infection in. Biting or picking at the cuticle, damage through work and overenthusiastic manicuring are the usual culprits. If someone has a cold sore and puts their finger in their mouth then a herpes infection whitlow may appear. Individuals who work with their hands in water, such as health care workers and food processors, are quite prone to the fungal type of infection.

What is an ingrown toenail

An ingrown toenail (onychocryptosis) occurs when part of the nail penetrates the skin, which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin – this is not technically an ingrown toe nail, but can also be painful (a corn/callus is also common down the side of the nail and is a reaction to this pressure, rather than the nail actually penetrating the skin).


What does an ingrown toe nail (onychocryptosis) look like:

Usually the side of the nail penetrates deep and it is difficult to see the edge of the nail. The severity of appearance of the nail will vary. Some will just have a nail that appears deeply embedded down the side or sides of the nail. In some the corner or a small spike of nail may penetrate the skin, just like a knife. This can result in an infection and the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.


What are the symptoms of in ingrown toenail (onychocryptosis):

Pain is the main symptom of an ingrown toe nail – usually just starting as some minor discomfort. This may be just the pressure from the side of the nail or it may be because the nail has actually penetrated the skin down the side of the nail. The toe is not necessarily infected, but this can develop after the nail penetrate the skin to become ingrown. The infection can spread, making the toe red and inflamed (paronychia). A collection of pus may also develop.

What causes an ingrown nail (onychocryptosis):

Poor cutting of the nail is most commonly blamed as being the cause of an ingrown toe nail, but this is not necessarily the case. The following factors are involved in the cause of ingrown toenails (onychocryptosis):

  • the primary risk factor is the shape of the nail – a nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail (incurvated nails). Some nails go down the side into the nail fold area for a relatively large distance. A large portion of the nail is almost vertical rather than being horizontal. The most severe of these types of nail is called a ‘pincer nail’ in which both side of the nail are very curved. The shape of the nail is usually inherited (congenital), but it can be influenced by trauma and/or shoe pressure.
  • poor cutting of these types of nails can leave a sharp corner (or if worse, a small spike) that will initially cause symptoms by putting pressure on the skin and then later penetrate the skin. Trimming too far down the sides is a common cause of an ingrown toe nail.
  • footwear that is tighter is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk on an ingrown nail.
  • previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail
  • pressure from the toe next to the nail that has ingrown can sometime be a factor
  • a ‘chubby’ or fleshy toe is more likely to have a nail grow into it. Those whose feet swell are a lot are more prone to having this happen.