I keep on getting recurrent paronychia. How can I prevent these infections?

Paronychia usually starts because of trauma to the skin near the nail. So to prevent a paronychia:

- avoid traumatizing your finger nails

- avoid the habit of biting your nails

- wear rubber gloves if your hands are constantly in contact with water

- if you are a diabetic, ensure that your blood sugar levels are under control

- if you work in a dirty environment, wash hands frequently

- wear protective gloves if you frequently deal with harsh chemicals

 Paronychia is an easily treated infection and the outlook is excellent

Does the nail ever have to be removed when one has a paronychia?

In some severe cases of paronychia where the infection has involved the fingernail, one may require partial or complete removal of the nail. In the majority of cases, antibiotics are very rarely required once the pus is drained. It is not necessary to obtain cultures from the fluid that is drained. However, some physicians may obtain cultures if the infection is severe. After drainage, one should continue with warm soaks. Healing takes anywhere from 5-7 days and in a few weeks the finger and nail will appear normal.

How is paronychia usually treated?

The treatment of a paronychia requires drainage of pus. This can be easily done in the physician’s office and takes less than 15 minutes. The entire finger is numbed and an incision is made on the side of the nail where the infection is most obvious. This will immediately relieve pain, redness, and swelling.

To ensure that all the pus is drained, some physicians may insert a small piece of gauze or wick in the incision. The wick will keep the wound open and allow pus to drain. This packing is left for about 24-48 hours. The finger should be soaked in warm water the next day and the wick replaced.

What can I do at home to treat my paronychia?

When a paronychia first develops, one should start home remedies at once. Soak the finger in warm water 3-4 times a day for at least 15-30 minutes each session. Soaking will relieve pain, redness, and swelling. There is a lot of debate about adding antibiotics or anti septic to the warm water soaks. In most cases, there is no need to do add anything. A simple soap and warm water is more than adequate. Because the finger can be painful, wear a splint or dress it in a thick gauze

How does a doctor make a Diagnosis of paronychia?

The diagnosis of a nail bed infection does not require any type of radiological study. Any physician with reasonable skills should be able to make a diagnosis of paronychia by looking at the nail. It is very rare to obtain any blood work or x-rays when a paronychia is suspected- unless you have a good insurance plan.

Can one drain the paronychia pus at home?

The treatment of pus in a fingertip usually requires a small incision to allow the fluid to drain. Pus drainage is not something that should be attempted at home, unless you have both medical personnel and sterile equipment at home.

Does one need to see a doctor for paronychia (infection of the nail edge?

Paronychia does not always have to be treated by a physician. In many cases, home remedies may help decrease redness and pain. However, there are times when the redness and infection extend to the entire digit and can be associated with severe pain. Further, the infection can extend into the deeper spaces of the fingertips. In such scenarios, a visit to a doctor or the Emergency room would not be a bad idea.

Can one have fever with a paronychia?

Paronychia usually starts with redness and swelling that is localized to the lateral edge  of the nail. Pain is constant and is made worse by pressing on the nail. Often, there may be a yellowish discharge from the nail edge. When the fingertip starts to swell, chances are that fluid has collected under the skin and is most likely pus (Abscess)

The most common symptoms of a paronychia are:

- Swelling

- Redness

- Pus collection

- Pain and tenderness to touch

In rare cases, one may develop a low grade fever

Why do I keep on developing Paronychia (infection on the edge of my nails?

Paronychia is commonly caused by bacteria that reside on skin. When the skin around the nail edges has been broken or damaged, these bacteria can easily cause an infection. Common causes which lead to skin damage around nails is nail biting, finger sucking, frequent dishwashing with bare hands, regular encounters with harsh chemicals and detergents or improper clipping of nails. Besides bacteria, fungi can also cause paronychia.

How does one treat nail biting?

For most people who bite their nails, treatment is only required if the nail biting is persistent and causes distress to the person. Additionally, if the habit is so severe that it has caused damage to the nails and recurrent infections, then it is wise to seek therapy.

The treatment of nail biting includes some type of behavior therapy that helps reverse the habit. These habit reversal treatments include relaxation, self-monitoring, reinforcement, use of bitter tasting substances on the nails and even wearing dental occlusive splints so that you cannot bite on the nail. However, in many adults who bite nails, behavior therapy alone is not affective and some type of drug therapy may be required. Many adults who practice nail biting also have emotional stress, anxiety or other behavior related problems. In such cases, these disorders also have to be addressed in order to successfully treat nail biting. 

The drugs of choice are the SSRIs. These medications have a  low risk of adverse reactions and they promote compliance. Overall, it appears that with therapy, 60-80 percent of people can be treated but there is a high relapse rate if stress is recurrent.

Is nail biting bad for health?

Nail biting is slightly more common in females at all ages. While nail biting may be benign, it can lead to extremely short fingernails, infections of the nail, oral herpetic infection, herpetic whitlow, damaged dentition, fracture of teeth and even gum infections. Moreover, the nail and finger often look aesthetically unpleasing.

Like most things in psychiatry, no one really knows why people bite their nails repetitively. Three common reasons include bad genes, a poor environment and a difficult childhood.

Is Nail biting a common habit?

Habits like nail biting are very common and often go unnoticed. However, often the repetitive nail biting can lead to severe injury to the fingers, leading to a variety of infections and deformities. Nail biting is commonly first seen in preschool age up to adolescence and is seen in as many as 50-60 percent of individuals. With time, most children grow up out of this habit. However, at least 3-8 percent of the adult population continue to bite their nails. The majority of these people who bite their nails have some degree of anxiety, obsessive compulsive personality or impulse control problem.

Nail biting 101

Many people engage in behaviors that range from nail biting, thumb sucking, foot tapping to more physically harmful behaviors like teeth grinding, hair pulling or head banging. Habit disorders consist of stereotypical repetitive; seemingly driven and non-functional motor habits that often interfere with normal activities and may lead to injury to a body part. The majority of these behaviors are considered harmless and considered part of normal growth and development, but in some cases, the habit persists into adulthood and can be very distressing.