In our daily life people mostly hurt their fingers, and it is quite natural because the mostly used limbs in human body are hands. Not only that, but also works from nailing on wall to writing on paper and even artistic works like painting and sculpturing cannot be done without using our priceless fingers. So, there is always a higher risk of having bacterial and fungal infections in our hands, especially in nails and fingers. Paronychia is one of them.

What is Paronychia or Infected Cuticle?

What is Paronychia or Infected Cuticle?

Paronychia is a nail disease caused due to bacterial and fungal infection. The area of this nail disease with infected cuticle is not only the finger nails, but also toes although it is less common. The infection may start suddenly with acute paronychia, or even gradually with chronic paronychia.

Types of Paronychia or Infected Cuticle

According to degree of infection, there are two types of paronychia or Infected Cuticle which are:

  • Acute Paronychia or Acute Infected Cuticle: Anyone can be affected by acute paronychia. In most of cases it is the result of bacterial infection. The infection of Staphylococcus aureus due to break in the skin results into acute paronychia or having acute infection of cuticle. Generally, the infection starts from the side of finger nail with redness, swelling and pain.
  • Chronic Paronychia or Chronic Infected Cuticle: Chronic means long term and this kind of paronychia starts gradually and not suddenly. So it takes time to notice the symptoms and to start the treatment. Generally, chronic paronychia is the result of fungal infection. In most of the cases it lasts for six weeks and this fungal infection starts due to local exposure of finger nail or toe nail to moisture. Not only that, but it can also be the result of contact dermatitis.

Signs and Symptoms of Paronychia or Infected Cuticle

Signs and Symptoms of Paronychia or Infected Cuticle

This nail skin disease due to bacterial and fungal infection comes with types of typical signs. The skin besides finger nail or even at the bottom of nail is found red and hot along with increased pain. Pus is normally found at the site of infection. The signs and symptoms of Paronychia or infected cuticle as per the types are as follows:

  • Signs and Symptoms of Acute Paronychia or Acute Infected Cuticle: There are some kinds of physical finding at the area of infection for acute paronychia.
    • The affected area of nail and the skin is found erythematous and swollen.
    • If the treatment is delayed, then the infection may extend into eponychium. It is named eponychia then.
  • Signs and Symptoms of Chronic Paronychia or Infected Cuticle: In case of chronic paronychia, there are also types of physical findings which includes:
    • It is also very common with chronic paronychia, that the infected area is erythematous and swollen.
    • As it is chronic and a long time infection, the nail plates gradually becomes discoloured and thickened.
    • Last but not least point, sometimes the nail fold and cuticles are found separated from the nail plates. This space is enough for various types of bacterial invasion and invasion of microorganisms.

Causes of Paronychia or Infected Cuticle

The causes of having an infected cuticle can vary as per the types. Let us have a look at the various reasons which causes the different types of paronychia or infection of cuticles.

  • Causes of Acute Paronychia or Infected Cuticle: This bacterial infection of nail skin happens due to the following reasons -
    • Application of sculptured or artificial fingernails.
    • Biting the finger nails may result into this nail infection with infected cuticle.
    • For infants due to sucking their fingers and thumbs.
    • Oral retinoid treatment which dries the skin.
  • Causes of Chronic Paronychia or Infected Cuticle: It is found that chronic paronychia mostly occurred in people due to hand dermatitis. There are certain occupations which also predisposes a person to have this infection. These include:
    • Fishermen
    • Dairy farmers
    • Bar tenders
    • House cleaners.

The work domain of these professionals makes their fingers and toes expose to the moisture and water. This leads to get affected by the fungal infection very easily, which results in chronic paronychia.

A special condition makes this nail skin disease more frequent and aggressive in some people. The patients of diabetes and chronic debility suffer more than a normal individual with chronic paronychia.

Diagnosis of Paronychia or Infected Cuticle

As it has been discussed that paronychia is caused due to bacterial and fungus infection, so it is important to do some pathological test in the laboratory.
Staphylococcus aureus is found responsible for the acute paronychia. Hence, a gram staining test with the patients’ skin tissue sample helps to diagnose the types of bacterial invasion in nail skin to cause the type of paronychia.

Moreover, to diagnose the fluctuant paronychia caused by a candidal infection, smear of Potassium hydroxide (KOH) 5% is used.

If there is a chance of herpetic whitlow, then Tzanck smear is also used to make proper diagnosis.

How is Paronychia or Infected Cuticle Treated?

The treatment for Paronychia or infected cuticle can be done based on the stage of infection.

  • Warm Soaks for Treating Paronychia or Infected Cuticle: In preliminary stages of acute paronychia where no pus is present, a person is recommended to soak his/her fingers in warm water. One can also add some salt or specifically Epson salts to it.
  • Drainage of Abscess for Paronychia or Infected Cuticle: With advancement of the infection to the second stage where there is a formation of abscess (pus formation), the common thing which is done by the doctor is drainage of the abscess for both acute and chronic paronychia. Doctors usually use Lidocaine, a kind of local anesthetic and numb the entire finger with the affected nail. An incision is made in the abscess (pus pocket) by using a surgical knife to drain out the pus. This is done because the bacterial invasion and infection with pus cell under the nail can spread the infection to other areas and also to blood which could be very dangerous.
  • Surgical Removal of Infected Nail: Sometimes in case of extreme level, the infection can spread and move under the finger nail and due to this reason partial or complete nail removal is mandatory. Normally antibiotics are not given to the patients until an extensive level of infection is not found.

Antibiotics like Bacitracin are recommended to apply on-site, but an individual with paronychia under treatment needs to follow up with doctor within 24 – 48 hours to get assured whether the infection is healing or not.

Home Remedies for Paronychia or Infected Cuticle

A number of home remedies can help one deal with infected cuticle. These include:

  • Soaking hands in warm water as soon as you notice onset of redness, swollenness and pain in the cuticle.
  • Take half a cup of vinegar and equal amount of water in a big bowl and soak your fingers and toes in this. Do this 3 times a day to stay away from paronychia.
  • Take 2-3 drops of Oregano oil and rub it in your fingers and cuticle to treat and prevent this infection.
  • Alternatively, you can also use Olive oil to rub in your fingers which will give the same benefits.
  • Take some warm water and add few drops of lemon juice to it. Now soak your fingers and toes in it to stay away from paronychia.
  • Grind 8-10 betel leaves and 10 gram of powdered quicklime and make a smooth paste. Apply the paste on the affected nail. You can also tie a clean, dry, cotton cloth around it to let the paste stay longer. This will cure the infected cuticle and also prevent further paronychia.

Prevention of Paronychia or Infected Cuticle

Early awareness and precautions are always welcome before anybody goes under this bacterial and fungal infection. So, few tips are mentioned below to stay away from the infection and pain of acute and chronic paronychia or infected cuticle.

  • Avoiding finger nail biting is the easiest way to avoid this fungal infection, because a bite can make scratch or break the skin around the nail and that is enough for bacterial and fungal invasion.
  • Usage of rubber gloves is necessary to avoid the moisture type exposure direct to fingers.
  • Chronic paronychia with the chronic illness like diabetes is definitely a deadly combination. So, it is better to control the diabetes first.
  • The last but most important point is, washing hands after working with dirt and where hands are getting soiled. There are various types of bacteria and microorganisms in soil, so washing hands is the only way not to let them insert into the finger nails.

Paronychia is a common cuticle infection that can happen to anyone due to various reasons. However, one must take proper care to prevent this infection. In case it happens, proper treatment must be taken depending on the stage of the infection. One must not ignore paronychia as negligence can advance the condition to stages where the infection spreads in the blood resulting in serious complications. A diabetic person must take additional care of their hands and feet including the nails as they are more prone to such infections and the cure also takes longer time.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 5, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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