Definition

• Mild bacterial infection of the skin fold next to the fingernail

Health Information

Symptoms

• Redness and swelling of the skin next to the fingernail
• Usually involves just one small part of the skin fold
• The red area is painful and tender
• The redness comes out over a few days
• A pus pocket (large pimple) may occur
• The medical name is acute paronychia

Causes

• Normally the nail plate (fingernail) and the skin fold forms a tight seal. The cuticle is a strip of dead skin cells. It seals the nail groove (the space between the skin and nail plate). It acts to fill this gap.
• If this seal is broken, it provides an entry for germs. Staph is the most common germ to infect the area.
• A hangnail is a loose piece of cuticle. Picking at, pulling or chewing a hangnail often starts the problem.
• Nail biting is another trigger.
• For teenagers, frequent manicures or using sculptured nails can cause this.

Care Advice

1. Overview:
   • This is a mild infection of the cuticle (skinfold around the fingernail).
   • It is usually caused by bacteria.
   • Pulling at hangnails or other injury to the cuticle often starts the process.
   • Usually, it can be treated at home.
   • Here is some care advice that should help.
2. Warm Soaks:
   • Soak the infected finger in warm water and an antibacterial soap.
   • Soak for 10 minutes.
   • Repeat 3 times per day until infection is gone.
3. Antibiotic Ointment:
   • Use an antibiotic ointment (OTC) to the area 3 times per day.
   • Cover it with a Bandaid.
   • Keep doing this until the redness and pain are gone.
4. Antibiotic by Mouth:
   • If the infection is spreading, your doctor may prescribe an antibiotic.
   • The drug will kill the germs that are causing the infection.
   • Give the drug as ordered.
   • Try not to forget any of the doses.
5. Pain:
   • To help with the pain, give acetaminophen (such as Tylenol) OR ibuprofen. Use as needed.
6. Pus Pocket Drainage:
   • Pus pockets need to be opened and drained.
   • Drainage is safer if done by a doctor.
   • If the pus pocket is small and your doctor wants you to open it, here’s how:
   • Use a needle. First, clean it with rubbing alcohol.
   • Make a large hole through the center of the pimple.
   • Help the pus come out with gentle pressure.
   • Throw away the needle and all the pus.
   • Keep using an antibiotic ointment 3 times per day.
7. Prevention of Recurrent Fingernail Infections:
   • Do not pick at or chew loose pieces of cuticle (hangnails). Instead, cut them off with nail clippers.
   • If your child is a nail biter, help him give up this bad habit.
   • For teens, avoid frequent manicures.
8. What to Expect:
   • With proper treatment, this mild infection should clear up in 3 days.
   • Sometimes, the redness will turn into a large pimple or pus pocket.
   • If this occurs, contact your child’s doctor to drain the pus.

Call Your Doctor If

• Pus pocket appears
• Spreading redness occurs
• Fever occurs
• Not gone by day 4
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

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