Merck Manual

Please confirm that you are not located inside the Russian Federation

Loading

Acute Paronychia

By

Chris G. Adigun

, MD, Dermatology & Laser Center of Chapel Hill

Last full review/revision Dec 2019| Content last modified Dec 2019
Click here for the Professional Version
Topic Resources

Acute paronychia is a bacterial infection of the cuticle.

In acute paronychia, bacteria (usually Staphylococcus aureus or streptococci) enter through a break in the skin resulting from a hangnail, trauma to a nail fold (the fold of hard skin at the sides of the nail plate where the nail and skin meet), loss of the cuticle (the skin at the base of the nail), or chronic irritation (such as that caused by water and detergents). Acute paronychia on the fingers is more common among people who bite or suck their fingers. In toes, infection often begins at an ingrown toenail. Some new drugs used to treat certain cancers or suppress the immune system (for example, after an organ transplant) also seem to sometimes cause acute paronychia. These drugs include gefitinib, erlotinib, sirolimus, everolimus, vemurafenib, dabrafenib, and related drugs.

Paronychia is usually acute, but chronic paronychia can occur.

Acute paronychia develops along the nail margin (the sides and base of the nail fold). Over the course of hours to days, people with acute paronychia develop pain, warmth, redness, and swelling. Pus usually accumulates under the skin along the nail margin and sometimes beneath the nail. Rarely, infection penetrates deep into the finger or toe and can threaten the digit or, in extreme cases, the arm or leg. These deeper infections mainly occur in people who have diabetes or other disorders that cause poor circulation.

The doctor makes the diagnosis of acute paronychia by examining the affected finger or toe.

Treatment

  • Antibiotics

  • Drainage of pus

In its earliest stage, acute paronychia may be treated with an antibiotic taken by mouth (such as dicloxacillin, cephalexin, or clindamycin) and frequent warm soaks to increase the blood flow.

If pus accumulates, it must be drained. The doctor numbs the finger or toe with a local anesthetic (such as lidocaine) and lifts up the nail fold with an instrument. Cutting the skin is usually unnecessary. A thin gauze wick can be inserted for 24 to 48 hours to allow the area to drain.

Drugs Mentioned In This Article

Generic Name Select Brand Names
No US brand name
ZELBORAF
CLEOCIN
KEFLEX
TAFINLAR
AFINITOR
XYLOCAINE
RAPAMUNE
TARCEVA
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read

Also of Interest

Videos

View All
Skin Cancer
Video
Skin Cancer
The skin is the largest organ of the body. It serves many important functions, including protecting...
3D Models
View All
Lymphangitic Streak
3D Model
Lymphangitic Streak

SOCIAL MEDIA

test
iOS Android
iOS Android
iOS Android
TOP