Paronychia
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Paronychia is inflammation of the folds of skin around a fingernail or toenail. It is often caused by infection, injury or irritation. The nail area is the most common place for infections of the hand. The main signs are a red, swollen, warm and tender edge of the nail, sometimes with pus. It is described as acute (sudden) or chronic (lasting more than 6 weeks). With the right care, a sudden infection can clear in a few days. Some signs mean it needs prompt medical assessment, and these are listed below.
What is it?
Paronychia (say pa-ro-NIK-ee-a) is inflammation of the nail folds, the skin and soft tissue that frame and support your nail. It can happen around a fingernail or a toenail. It is often caused by infection, injury or irritation.
It usually starts when the seal between the nail and the skin beside it breaks down. This lets germs in. Doctors describe it as acute if it comes on suddenly, or chronic if it lasts more than 6 weeks.
Paronychia is not the same thing as a nail growing into the skin at its base (called retronychia). That is a different problem, although it can lead to paronychia.
Who does it affect?
The nail area is the most common place for infections of the hand. Paronychia can affect adults and children.
You are more likely to get it if you bite or pick at your nails, have manicures or wear artificial nails, or do a lot of wet work at home or at work. People with ingrown toenails often get it in their toes. In fact, sudden paronychia of the toes mostly happens alongside an ingrown toenail.
Adults who take a type of cancer drug called an EGFR inhibitor are also at higher risk. Among adults with a type of lung cancer treated with these drugs, between 4 and 56.8 per cent had paronychia of some kind. Between 0 and 11.4 per cent had a severe form. These figures apply only to people taking these drugs, not to everyone.
Signs and symptoms
The edge of the nail becomes red, swollen, warm and tender. The finger or toe can be painful, especially when touched. Pus (a thick yellowish fluid) may collect under the skin next to the nail or under the nail itself. If it isn't treated, the nail can become infected or damaged.
A sudden (acute) paronychia usually shows up 2 to 5 days after the trigger. It usually affects just one finger or toe, with redness, swelling, pain and tenderness along the side or base of the nail. In a toe, the pain can be felt on all sides of the nail and on top of it.
A long-lasting (chronic) paronychia comes on more slowly. It usually affects more than one nail and is less painful. The nail itself may change, becoming thicker, ridged or discoloured.
What causes it?
An injury to the cuticle or nail fold is the usual trigger. It can be a small injury, such as nail biting, a manicure, wet work, or a splinter or other foreign object stuck in the skin. These injuries let germs in. Sudden paronychia is mostly caused by bacteria from the skin, most often Staphylococcus aureus and Streptococcus pyogenes. Yeast (Candida) and the cold sore virus are less common causes.
Chronic paronychia is linked to loss of the cuticle (the thin seal of skin at the base of the nail). Its causes are varied. It can be a skin condition, or a yeast or fungus rather than bacteria.
In people taking EGFR inhibitor cancer drugs, the drug changes how the skin around the nail behaves. This causes inflammation. It usually appears 1 to 6 months after starting the drug, and it can affect daily life a great deal.
How is it diagnosed?
Your podiatrist will look at the area and ask some questions. These may include how long it has been there, how many nails are involved, whether there is pus, and whether the nail has changed. They will also ask about things that may have set it off, such as nail biting, manicures, wet work, toenail problems and cancer drug treatment. They will ask about diabetes, circulation and your immune system too.
Some other conditions can look like paronychia. Painful clusters of tiny blisters with no real pus can be a viral infection called herpetic whitlow. Skin conditions such as pustular psoriasis, pemphigus and reactive arthritis can also look like it. Clues include several fingers or toes being affected, or typical nail changes. A test may be needed to sort out what is going on.
If it lasts more than 6 weeks or doesn't respond to usual treatment, your doctor may look for other causes.
Treatment
A mild, early infection can often be treated simply. Treatment depends on whether there is pus, how long the problem has lasted, and your general health. It isn't yet clear which of the options below works best.
Looking after it at home
Warm soaks are the usual first step for a mild, early case. Your practitioner may suggest adding Burow solution or 1% acetic acid to the water.
For children, soaking the infected finger in warm salted water four times a day often clears the infection in a few days. Simple painkillers such as ibuprofen or paracetamol can ease the pain. Follow the packet directions or ask your pharmacist.
Treatment from your podiatrist
Your podiatrist will check the nail fold and look for an ingrown nail, because the nail is often part of the problem in the toes. They will advise on soaks and care of the area. They will also arrange medical review where you need it, for example if you have diabetes or poor circulation.
If soaks don't settle the inflammation, a doctor may prescribe a cream containing an antibiotic, sometimes with a steroid.
Other options
Oral antibiotics are sometimes used for sudden paronychia. When the cause is an ingrown nail, antibiotic tablets aren't used routinely unless an infection is proven.
For long-lasting paronychia, steroid creams are the main treatment. Antifungal medicines are used only if a yeast (Candida) infection is also present. If it has lasted more than 6 weeks, your GP can review it. A skin specialist (dermatologist) may see you too. If it still doesn't respond, your doctor may check for less common causes.
If you take an EGFR inhibitor and the paronychia becomes severe (grade 3), the usual approach is to pause the drug until it improves. You would also be referred for specialist support, from a dermatologist or podiatrist as appropriate. Your cancer care team will guide this.
Surgery
A collection of pus (an abscess) should always be drained. Severe sudden bacterial infections often need a small procedure to prevent lasting harm. Milder infections, and slower or long-lasting ones, are usually managed more gently.
If a cluster of tiny blisters turns out to be herpetic whitlow, it should not be cut open or drained. It needs non-surgical treatment.
For people on EGFR inhibitors whose severe paronychia doesn't improve, surgery may be considered, sometimes with antibiotics through a drip.
Recovery
With treatment, a sudden infected nail fold can clear up in a few days. If it hasn't settled in the time your practitioner expected, or if it returns, book a recheck rather than repeating the same care.
How long long-lasting or toenail paronychia takes to heal isn't clear yet. How often paronychia comes back, and what changes recovery, also aren't clear yet.
Preventing it
Avoiding the known triggers is a sensible step. These include nail biting and picking, injuries to the cuticle or nail fold, and long periods of wet work. How well this stops paronychia coming back isn't clear yet.
If you hurt a nail or have an ingrown toenail, get it looked at early, since these are common starting points. If you take an EGFR inhibitor, tell your medical team about any nail changes at the first sign.
When to see a podiatrist
When to book
Book an appointment with your podiatrist if the skin around a nail is red, swollen, sore or warm, if there is pus around the nail, or if soaks haven't helped. Also book if you have an ingrown toenail, or if the problem keeps coming back. See your GP if it has lasted more than 6 weeks, hasn't responded to treatment, affects several nails, or comes with nail changes. See your GP soon if you have painful clusters of tiny blisters with no real pus, and don't let anyone cut them open, because this can be a viral infection that needs different treatment.
When to get help sooner
Call your local emergency number if you have a nail infection and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, because this could be sepsis. The following need urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department. Go for a fever, feeling sick or being sick, or being unable to bend your finger properly (in children, unable to fully bend a finger joint). Go if pus comes back after antibiotics or drainage. Go if the redness, swelling or pain around the nail is increasing (in children, also if swelling is new or bigger, or the pain is moving further up the finger). Go if an ingrown toenail looks infected. Go if you have diabetes, poor circulation or a weakened immune system and a nail infection, because foot problems can be more serious. If you take an EGFR inhibitor cancer drug, tell your medical team at the first sign of nail changes, because mild paronychia can worsen very quickly.
Frequently asked questions
Is paronychia the same as a nail fungus?
No. Paronychia is inflammation of the skin folds beside or at the base of the nail. Sudden cases are mostly caused by bacteria. Long-lasting cases can involve a yeast or fungus, but the nail plate itself isn't necessarily infected. If it lasts more than 6 weeks, your GP can look into the cause.
How is paronychia different from an ingrown toenail?
An ingrown toenail is a nail pressing into the skin beside it. Paronychia is the inflammation or infection that can follow. Sudden paronychia of the toes mostly happens alongside an ingrown toenail, so your podiatrist will check the nail as well as the skin.
What is a whitlow, and is it the same thing?
Some people use the word whitlow for an infected nail fold. A herpetic whitlow is different: it is a viral infection with painful clusters of tiny blisters but no real pus. It can look like an abscess, but it shouldn't be cut open. A GP can arrange testing.