Nail fold infections can be painful and interfere with daily activities. They may also spread around the nail to neighboring areas, or to other nails. It is therefore necessary to diagnose and treat them in time.
Most of these conditions are diagnosed clinically. Nail scrapings or clippings may help in doubtful cases, or if a culture needs to be taken. It is interesting that toenail infections take a longer time to heal than fingernail infections do.
Principles of Treatment
Antibiotics should be taken to treat bacterial infections of the nail fold. In most cases, acute bacterial paronychia is treated with a seven-day course of antibiotics. Hot fomentation in saline solution may also be helpful. Over-the-counter painkillers may be taken for severe pain. If the antibiotics are not working, a culture may need to be taken to test the bacterial sensitivity, and adjust the medication.
Penicillin and its derivatives such as ampicillin are the most effective antibiotics in nail infection, especially if caused by biting the nails or sucking the fingers. However, if the organisms are likely to be resistant, as with Staphylococcus or Bacteroides, Clindamycin or Augmentin (which contains ampicillin with clavulanate) are more appropriate.
In addition, a small incision may be required if a paronychial abscess forms. This is usually done under digital block anesthesia. If the skin over the abscess is yellowish-white the nerves are already dead and no anesthesia is required. The incision is made with a sterile small lancet, being careful to point the blade away from the nail. This will avoid inadvertent nail bed injury which will result in growth problems. The pus is expressed and the abscess cavity packed, while oral antibiotics are also prescribed. After 48 hours, the dressing is removed and regular warm soaks help to cleanse the cavity and promote healing. A light bandage is used in between soaks to keep it clean.
Chronic paronychia is caused by a combination of chemical irritation, trauma, exposure to wetness, and allergic reactions in some cases. Preventing future exposure is crucial, and gloves should be worn. The hands should be kept dry and clean. Topical steroids and antifungal ointment should be continued till it is healed. Antibacterial soaks are sometimes recommended to prevent secondary bacterial infection.
Surgery consists of marsupializing the cuticle or nail removal in cases when the medical treatment fails. The topical application of antifungal and steroid medication on the nail bed should be continued.
Fungal Nail Fold Infections
Antifungals are used to treat fungal nail infections. Since fungal infections are chronic, the medications should be continued for 3-6 months. In some cases, the topical antifungal is not effective, and oral antifungal therapy is required. If the infection affects the nail plate, treatment with oral antifungal tablets or antifungal paint is continued for up to 12 months.
Prevention of Recurrence
Any identified underlying condition or aggravating factor such as eczematous dermatitis or diabetes mellitus should be treated.
Nails should be carefully trimmed and future care should be advised. This includes:
- Keeping the hands dry and clean
- Wearing gloves with a cotton liner when working with chemicals or water
- Not covering your hands or nails (for instance, with artificial fingernails) all the time
- Avoid biting your nails
Reviewed by Susha Cheriyedath, MSc