Even minor injuries can lead to bacteria and fungi penetrating through the cuticle, nail fold or nail wall into the skin of the nail bed and thus causing painful nail bed inflammation (medically also called onychia, paronychia, panaritium). This infection is one of the most common finger diseases.
What is nail bed inflammation?
The nail bed is the tissue on the finger or toe from which the nail grows and is covered. Depending on whether the mostly bacterial infection only affects the nail bed itself or also the so-called circumference of the nail, a distinction is made between two types of nail bed inflammation:
In parungual panaritium, the infection affects the posterior or lateral nail wall. This causes swelling and redness. The subungual panaritium is located under the nail. This leads to suppuration at the nail root or at the free nail wall. See psyknowhow for Metastases Explained.
Inflammation of the nail bed occurs when certain pathogens, mostly staphylococci, but also fungi and herpes viruses, penetrate the skin of the nail bed through entry points. Even small cracks that occur during nail care, ingrown nails, cuts and irritation of the skin can serve as the gateway to such an infection.
Even shoes that are too tight can lead to an injury in the area of the toenails. The resulting nail bed inflammation can be both acute and chronic.
People who tend to dry skin or atopic eczema (neurodermatitis), people who regularly come into contact with aggressive cleaning agents, who take certain medications, have diabetes, suffer from circulatory disorders or whose immune system is weakened are also considered to be particularly at risk.
However, women are affected more often than men because they tend to injure their nails from pedicures and manicures.
Symptoms, Ailments & Signs
Nail bed inflammation manifests itself through a number of clear symptoms. The inflammation first becomes noticeable through external changes in the nail area: the skin is very reddened and the tissue swells and hurts. The pain is usually described as throbbing or stabbing. The increase in pressure in the affected tissue also causes the infected skin areas to overheat.
The skin then feels noticeably hot and is very sensitive to touch. The inflamed areas may also ooze or have a bluish discoloration. After a few days, pus forms on the lateral edges of the nail. These pus spots open up again and again due to the constant strain on the finger, which can result in another infection. Complaints such as fever and malaise accompany the nail bed inflammation.
Those affected often also notice swelling of the lymph nodes in the crook of the arm and armpits. Chronic inflammation can cause the nail to detach. In addition, the inflammation can spread to the surrounding fingers or toes. Then there is painful swelling, which restricts freedom of movement and is associated with severe discomfort. In severe cases, chronic bone inflammation develops.
Diagnosis & History
Characteristic of an inflammation of the nail bed are areas sensitive to pressure as well as redness and swelling, which increasingly cause throbbing pain.
The first sign, however, is a reddening of the skin adjacent to the nail. Over time, the skin swells and feels overheated. Itching can also occur, especially in the initial phase of the infection. Eventually, foci of pus form on the edges of the nail wall or under the nail.
If there is no timely treatment, this inflammation can spread so that in extreme cases it can penetrate to the tendon sheaths and the bone. Growth disorders of the nail up to complete rejection are also possible.
The chronic form of nail bed inflammation is often less painful than the acute one, whereby several nails are usually affected at the same time and the nail fold can turn bluish or reddish.
Depending on the severity of the infection, the doctor treating you can take a swab from the affected area of skin in order to be able to precisely determine the pathogen. If it is probably a chronic inflammation of the nail bed, the causative diseases or habits must be determined.
Complications due to nail bed inflammation are rarely to be feared. Inflammations that are recognized in good time and treated professionally usually heal without consequences. Minor deformations may sometimes remain, but this is only of cosmetic importance. On the other hand, there is a risk of sequelae if the therapy is not started early.
One of the most common complications of nail bed inflammation is its spread to neighboring body structures. These are primarily the posterior and lateral sections of skin that border the nail. In the further course, the inflammation can spread so far that it also affects the entire toe or finger. Nail bed inflammation not only spreads sideways, but can also penetrate deeper into the affected toe or finger.
In the worst case, the triggering bacteria work their way up to the bone and cause damage to it. The lymph nodes are also considered to be at risk. These can be reached by the bacteria via the lymphatic system. If the bone is affected, medical treatment must take place immediately, otherwise there is a risk of permanent impairment. The treatment is primarily with antibiotic tablets, which act against the bacterial pathogens.
If the germs spread to other parts of the body, there is a risk of secondary diseases such as arthritis in the joints or bone inflammation. If the bacteria reach the bloodstream, there is a risk of blood poisoning (sepsis), which in extreme cases can be life-threatening. This complication manifests itself in flare-ups of fever.
When should you go to the doctor?
In order to avoid an increase in symptoms and complications, a doctor should clarify a slight infection of the nail bed as soon as it starts. In consultation with the doctor, self-help measures or medical preparations can be used and healing promoted. At the latest when home remedies such as baths or creams are no longer effective, a doctor’s visit is recommended. If the pain gets worse or is accompanied by weeping or purulent areas, the doctor must be informed. The same applies if fever, swelling or sensory disturbances occur.
A bluish discoloration indicates advanced onychia that needs immediate evaluation and treatment. If you suffer from a chronic illness such as diabetes or circulatory disorders, it is best to consult the responsible doctor. With a nail bed inflammation, the family doctor can be consulted first. Depending on the suspicion, the patient must then turn to a dermatologist or a surgeon. If treated early, onychia will subside after a few days without expecting further complications or long-term effects.
Treatment & Therapy
Disinfectant solutions or creams can enable rapid healing as the first measures in the event of an imminent nail bed infection. Bathing the affected fingers/toes in chamomile tea often promises a reduction in the infection.
However, if redness, swelling, pain, possible functional impairments and a warm feeling occur, a doctor should be consulted immediately. Treatment of the disease always depends on the pathogen. Depending on whether the inflammation was caused by yeast, bacteria or viruses and whether another disease could be the cause of chronic nail bed inflammation, different drugs are used.
If the inflammation has progressed so far that fever occurs and the lymph nodes swell, antibiotics can also be prescribed. Antifungal ointments are also prescribed for yeast infections. Herpes viruses, on the other hand, can be treated well in the form of antivirals that are applied as ointments.
Since nail bed inflammation is associated with pain and impairment of the function of the respective finger/toe, immobilization with small splints or elevation may often be necessary. If the nail bed inflammation is in a more advanced stage, surgical intervention can also be considered. Here, the doctor opens the pus source under anesthesia by either removing the nail completely or inserting it through an access point. The pus located there is then drained and the wound is treated with a disinfecting ointment bandage. If a nail had to be removed for the opening, it usually grows back within a few months.
If the infection is caused by disturbed nail growth, for example due to an ingrown nail, which is responsible for the inflammation, the nail can be reduced in size during an operation. Since malpositions of the foot can also lead to injuries and, as a result, to disease of the nail bed, orthopedic insoles can also be prescribed.
In rare cases associated with impaired wound healing and dead tissue, amputation is eventually required to prevent the infection from progressing.
Outlook & Forecast
The vast majority of acute nail bed inflammation is free of complications and heals completely on its own within a few days to weeks. In more severe cases, treatment with antibiotics may be necessary. If pus has accumulated under the nail that cannot drain, the pus must be opened by a doctor. Otherwise, the nail can become detached, and in the worst case even life-threatening blood poisoning.
For a positive course of healing, it is necessary to eliminate the causes of the inflammation. Very often it is a matter of mistakes in nail care that lead to small injuries through which bacteria can penetrate into the nail bed. The biggest risk factor here is the removal of the protective cuticle, but ingrown nails can also cause nail bed inflammation. Another possible cause is contact with caustic cleaning substances. Appropriate protective measures must be taken here. If severe pain occurs, a doctor should be consulted.
The prognosis is less favorable for chronically ill people who suffer from neurodermatitis or diabetes because their immune system is already weakened. Dry skin causes cracks that can become infected. Severe courses, in which the inflammation can also spread to the surrounding tendons or even the bones, are rare and usually only observed in people with a weakened immune system.
As a preventive measure, ensure that fingernails and toenails are trimmed regularly to prevent them from growing in or breaking off. When filing, you should never go too deep into the lateral wall. Cuticles should also not be removed with scissors, but with a rounded slider.
Regular hand and foot baths as well as oils and creams keep the skin supple and counteract cracked, dry skin. Gloves should always be used when working in the garden or with chemicals. In the area of the feet, care should be taken to wear well-fitting shoes that do not create a feeling of pressure. In addition, special gymnastic exercises can stimulate blood circulation.
The nail bed inflammation can experience lasting regeneration through consistent aftercare. Targeted follow-up care can often prevent a relapse. In this context, it is ideal if the trigger of the nail bed inflammation is known.
If the cause is excessive nail care, it is aftercare and prevention at the same time to stop these habits. Sharp cleaning products and excessive shortening of the nails or cutting of the cuticles should be avoided as part of the aftercare. Nail polish and nail polish remover also have irritation potential, which is why patients should avoid using them. Torn nails can be treated gently and professionally in foot care.
If exposure to chemicals, for example at work, is responsible for the nail bed inflammation, this is also an important topic in aftercare. Wearing gloves, for example, is a measure that can possibly prevent inflammation. This also applies to gardening, where soil in the area of the nail bed can also trigger inflammation or prevent an inflammation from healing.
If inflammation occurs frequently, this can also be due to an immune deficiency or diabetes. After clarification by the family doctor, it often makes sense during follow-up care to effectively and long-term strengthen the immune system of the person affected by eating healthy, getting enough sleep and drinking enough water.
You can do that yourself
Measures to combat nail bed inflammation can also be done by self-help in addition to treatment with medication. So that the painful bacterial infection on fingernails or toenails can have less of an impact on everyday life, they should first be hygienically bandaged and thus protected. On the one hand, this reduces sensitivity to pain when touched or bumped. On the other hand, this can also prevent further contamination. Minor injuries that allowed bacteria to enter could otherwise remain a vulnerability.
If it is a nail bed inflammation of a toe, shoes that are too tight should not be worn. The purulent inflammation can be treated in various ways. Brushing with clove oil or garlic stock is helpful. A compress with arnica is also useful. The affected foot or hand should also be bathed in warm water several times a day. This softens the horny layer and allows for better drainage of pus. Bath additives such as chamomile and salt also have an anti-inflammatory effect.
The nail affected by nail bed inflammation can also be bathed in lukewarm tea made from marigold blossoms and rosemary. Dissolving two tablespoons of curd soap flakes per liter of water is an old, proven household remedy for an inflamed nail bed. The suppuration process can be promoted by Silicea (silicic acid) in the case of nail bed inflammation.