Inflamed nail: symptoms, causes and treatment

An inflamed nail, medically called paronychium, is an infection of the nail wall, the tissue that surrounds your nail on the sides. Your nails play an important protective role for the sensitive nerve endings at the tips of your fingers and toes. They grow throughout your life, at a rate of around 2 to 3 millimeters per month. The nail plate is the visible, hard part that forms your nail. At the base of your nail is the cuticle, a skin line that forms the transition between your normal skin and the nail. The sides of your nail are in the nail wall, the tissue on both sides of the nail.

In paronychium, this tissue becomes infected. This infection usually occurs when bacteria, often of the Staphylococcus aureus type, enter through minor damage in the skin. This can be a tiny wound that you've barely noticed, a crack in the skin, or an opening caused by cuticle ruptures. Once invaded, the bacteria multiply and cause local inflammation.

Nail inflammation can manifest itself in two ways. In an acute form, the infection occurs suddenly and develops rapidly within a few days. This is often accompanied by severe pain and marked swelling. The chronic form, on the other hand, develops more slowly and can last for weeks to months. This chronic variant mainly occurs among people who come into frequent professional contact with water, such as hairdressers, cleaners, chefs or people who work in healthcare. The constant contact with water soaks up the skin and makes it more vulnerable to bacteria.

Understanding how nail infections develop helps you prevent and treat them better. The most common cause is a bacterial infection with Staphylococcus aureus. This bacteria can cause problems when it accesses deeper tissue through minor damage in the skin.

There are various ways in which such damage can occur. Cutting your nails too short, especially in the corners, easily damages the skin around the nail edge. Tearing off or cutting cuticles creates small wounds where bacteria can enter. Nail biting is another major risk factor where people not only damage the nails themselves but also the skin around them continuously. Trauma to the fingers or toes, such as bumps or bruises, and an unhygienic manicure or pedicure can also lead to minor injuries.

Prolonged contact with water plays a major role in the development of chronic nail infections. When your hands or feet are regularly wet, the skin around your nails soaks up and becomes more vulnerable. Your skin's natural protective barrier is affected, making it easier for bacteria to enter. This explains why people who work as hairdressers, cleaners, kitchen staff or in healthcare are extra sensitive to chronic nail infections. Using harsh cleansers without gloves additionally damages the skin and increases the risk of infection.

In children, sucking fingers is an important risk factor for chronic nail infections. The saliva makes the skin constantly moist, which leads to the same problems as with professional water contact. Certain underlying conditions such as diabetes, a weakened immune system, or skin conditions such as eczema or psoriasis can also make you more susceptible to nail infections.

The symptoms of nail inflammation differ slightly between the acute and chronic form. In acute nail inflammation, you often start with a feeling of discomfort around the nail. This quickly develops into distinct pain that can be throbbing and gets worse when touched or pressed. The nail wall turns red, feels warm and swells. This swelling can be quite extensive and include the entire tip of your finger or toe. The pain often has a throbbing character and you can even feel the finger or toe throbbing without touch. Typing or writing can be painful with fingers; wearing shoes can be uncomfortable with toes.

As the acute infection progresses, fluid or even pus may develop under the nail plate. This moisture sometimes pushes the nail up slightly, making it looser on the nail bed. You can see this as a slight discoloration, often yellowish or greenish, under the nail. Pus can also form on the nail wall itself, which is visible as a yellowish white accumulation under the swollen skin.

In chronic nail infections, the initial inflammatory signs such as redness and swelling are also present, but these are often less severe. The pain is usually less intense and more of a persistent discomfort. A characteristic phenomenon in chronic cases is the formation of granulation tissue, also known as “wild meat”. This is new, rapidly growing tissue that occurs in response to persistent irritation. It looks like red, fleshy tissue at the edge of the nail that can sometimes even grow over the edge of the nail and bleeds easily when touched.

In both forms, changes can occur in the nail itself. The nail plate may become discolored with yellowish, green or brown spots. There may be grooves or ripples that run across the nail. In severe or prolonged cases, the nail may partially detach from the nail bed, showing as a white or yellowish area under the nail. In the case of chronic infections, the structure of the nail can also change: thicker, more brittle, or, on the contrary, softer and easier to break.

In principle, nail infections can occur on any nail, but there are clear patterns. In nail infections on the hands, the thumb and index finger are most commonly affected, probably because these fingers are the most used and therefore more likely to come into contact with potential sources of infection. In people who work where their hands are regularly wet, chronic nail infections can occur on several fingers at the same time. Children who suck their fingers typically develop nail infections on the fingers they put in their mouths, usually the thumb or index and middle fingers.

Nail infections are less common on the toes than on the fingers. The big toe is most commonly affected because it is the most exposed to pressure in shoes and is more sensitive to trauma. Shoes that are too tight can press the nail wall against the nail, causing irritation. Fingernail infections are much more common than toenail infections because our hands are much more exposed to water, chemicals, and situations where minor injuries can occur.

The treatment of nail infections depends on the severity and whether it is an acute or chronic form. In case of a beginning, mild nail inflammation, you can already start treatment at home. Disinfecting the affected finger or toe on a daily basis is the first step. To do this, you can use an iodine-containing disinfectant that you apply with a cotton swab two to three times a day. Hot baths or soaking baths can also help: soak your finger or toe in warm water for ten to fifteen minutes several times a day, possibly with salt added. This reduces swelling and helps open small accumulations of pus.

When a clear collection of pus has formed, professional help is needed. Your doctor will need to cut the purulent nail wall to remove the pus, often after a local anaesthetic. After removing the pus, you will be instructed to take a disinfecting bath at home twice a day, followed by applying an antibiotic ointment. In most cases, this approach is sufficient and the inflammation heals within one to two weeks.

In the case of severe, rapidly spread or deep infections, oral antibiotics are necessary. Your doctor will then prescribe a course of treatment that usually lasts five to seven days. It is important to complete the full course, even if the symptoms improve earlier. For chronic nail infections with granulation tissue formation, a minor surgical procedure is sometimes necessary. Under local anesthesia, the doctor removes a strip of approximately five millimeters from the nail edge. The resulting quarry is then treated with phenol, which ensures that this piece of nail does not grow back. The result is a slightly narrower nail that can no longer be irritated on that side.

In the case of chronic nail infections, it is also essential to address the underlying cause. If your work is caused by constant water contact, a temporary work stoppage is sometimes necessary to allow your hands to fully heal. After healing, it is important to take preventive measures, such as wearing waterproof gloves while working.

In the case of nail infections, there are some approaches that are not effective or may even worsen the problem. Trying to remove pus independently by squeezing or pricking the inflamed nail wall is dangerous. This can push the infection deeper, cause additional damage, and even lead to the spread of the bacteria. A doctor has sterile instruments and the right technique to remove pus safely.

The idea that you can cure a nail infection just by applying an antibiotic ointment without further measures is not entirely correct. In case of deeper infections or when pus is present, ointment is often not sufficient because it does not penetrate deeply enough. In the case of chronic nail infections, it is not sufficient to treat the acute infection alone without addressing the underlying cause. When you keep working with your hands constantly in the water without protection, or when a child keeps sucking their thumb, the inflammation comes back again and again.

The use of self-invented home remedies is usually ineffective and can sometimes even cause additional irritation. In case of a real bacterial infection, you need medical treatment. Using old medicines that you still have lying around independently is also not wise, and ignoring nail inflammation in the hope that it will go away on its own can lead to serious complications.

Does nail inflammation go away on its own?

A mild, beginning nail infection can sometimes heal on its own, especially if you give the finger a rest and keep it clean. However, as soon as there is obvious swelling, redness and pain, or when pus has formed, it rarely goes away on its own without treatment. It is therefore wise to contact your doctor if there are obvious signs of inflammation.

Is nail inflammation contagious?

The bacteria that cause nail infections normally live on the skin and are not directly contagious from person to person. However, the bacteria can be transmitted through close contact or through shared objects such as towels or nail clippers. It is therefore wise not to share personal care items.

Why do some people often get nail infections?

People who regularly get nail infections often have a combination of risk factors. Occupational contact with water is the main cause of recurrent chronic nail infections. Certain skin conditions, diabetes, a weakened immune system, or habits such as nail biting also increase the risk. Ingrown nails can also be a cause.

Can I keep working with a nail infection?

This depends on your profession and the severity of the inflammation. When working where your hands stay dry, it is often possible to continue working. In occupations where you come into frequent contact with water or work with food, it is wise to temporarily do other work or take time off. Talk to your doctor about what's best for your situation.

How do I prevent nail infections?

Prevention starts with good hand care. Cut your nails carefully and not too short, especially in the corners. Don't pick or tear cuticles. Try to stop biting your nails. Keep your hands and feet dry. If you work a lot with water professionally, wear waterproof gloves. Use a moisturizer to keep your skin supple.

When should I see a doctor with a nail infection?

See your doctor if your nail inflammation does not improve after two to three days of self-treatment, if the pain is severe, if you have obvious suppuration, if you have red stripes running from the finger to the hand, if you have a fever, or if you have diabetes or a weakened immune system. Professional help is also important for chronic nail infections that keep coming back.

1. Skindr dermatologists
2. Health & Science, Inflamed Nail (Paronychium) and Ingrown Nail
3. Thuisarts.nl, Cuticle inflammation
4. eBPNet (Evidence-Based Practice Network)