Nail Bed Inflammation: Causes, Symptoms & Treatment

Even small bruises can lead to the penetration of bacteria and fungi through the cuticle, nail salt or nail wall into the skin of the nail bed, causing a painful nail bed inflammation (medically also called onychia, paronychia, panaritium). This infection represents one of the most common diseases of the fingers.

What is nail bed inflammation?

The nail bed is the tissue on the finger or toe from which the nail grows out and is covered by it. Depending on whether the mostly bacterial infection exclusively affects the nail bed itself or additionally the so-called circulation of the nail, one distinguishes between two types of nail bed inflammation:

In panaritium parunguale, the infection affects the posterior or lateral nail wall. Swelling and redness occur as a result. Panaritium subunguale is located under the nail. In this case, suppuration occurs at the nail root or else at the free nail wall.

Causes

Nail bed inflammation occurs when certain pathogens, mostly staphylococci, but also fungi and herpes viruses, enter the skin of the nail bed through entry sites. Even small cracks that occur during nail care, ingrown nails, cuts as well as irritations of the skin can serve as a gateway for such an infection. In the area of the toenails, even shoes that are too tight can lead to an injury. Resulting nail bed infections can be both acute and chronic. People who tend to have 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 more often affected than men, as they are more prone to injuries in the nail area due to pedicures and manicures.

Symptoms, complaints and signs

Nail bed inflammation manifests itself through a number of distinct symptoms. First, the inflammation is noticeable by external changes in the nail area: The skin is very red 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 areas open again and again due to the constant stress on the finger, which can result in further infection. Accompanying the nail bed inflammation are complaints such as fever and malaise. Sufferers often also notice swelling of the lymph nodes in the elbow and armpit areas. Chronic inflammation can cause the nail to detach. In addition, the inflammation can spread to the surrounding fingers or toes. Then painful swellings occur, which restrict the freedom of movement and are associated with a strong discomfort. In severe cases, chronic bone inflammation develops.

Diagnosis and course

Characteristic of nail bed inflammation are both strongly pressure-sensitive areas and redness and swelling, which cause increasingly throbbing pain. The first sign, however, is redness of the skin area adjacent to the nail. In the course, the skin swells and feels overheated. Especially in the initial phase of the infection, itching may also occur. Eventually, foci of pus form at the edges of the nail wall or under the nail. If no timely treatment takes place, this inflammation can spread, so that in extreme cases it penetrates 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 form, whereby several nails are usually affected at the same time and these can become bluish or reddish in color at the nail root. Depending on the severity of the infection, the attending physician may take a swab from the affected skin area to determine the exact pathogens. If it is probably a chronic nail bed inflammation, causal diseases or lifestyle habits must be determined.

Complications

Complications due to nail bed inflammation are rarely to be feared. Thus, inflammations that are recognized in time and treated professionally, heal in most cases without consequences. Sometimes minor deformations may remain, but this is only of cosmetic significance. Consequential symptoms, on the other hand, are imminent if the therapy is not started early. One of the most frequent complications of nail bed inflammation is its spread to neighboring body structures. These are mainly the posterior and lateral skin sections adjacent to the nail. As it progresses, the inflammation may spread to affect the entire toe or finger. Nail bed inflammation not only spreads laterally, 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 trigger damage to it. The lymph nodes are also considered to be at risk. These can be reached by the bacteria via the lymphatic channels. If the bone is affected, medical treatment must take place immediately, otherwise there is a risk of permanent damage. 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 becomes noticeable through episodes of fever.

When should you go to the doctor?

In order to avoid an increase of the complaints as well as complications, already a beginning, light nail bed inflammation should be clarified by a physician. In consultation with the medical professional, self-help measures or medical preparations can be used and the healing promoted. A visit to the doctor is recommended at the latest when home remedies such as baths or creams no longer have any effect. If the pain becomes more severe 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, which must be examined and treated immediately. Those suffering from a chronic disease such as diabetes or circulatory disorders should at best consult the responsible physician. With nail bed inflammation, the general practitioner can be consulted first. Depending on the suspicion, the patient must then consult a dermatologist or even a surgeon. With early treatment, an onychia subsides after a few days without further complications or late effects.

Treatment and therapy

As first measures in case of a nail bed inflammation announcing itself, disinfecting solutions or creams can enable a quick healing. Baths of the affected fingers/toes in chamomile tea also often promise a decrease in the infection. If, on the other hand, redness, swelling, pain, possibly functional impairment and a heated sensation occur, a doctor should be consulted immediately. Treatment of the disease always depends on the pathogen. Depending on whether the inflammation is caused by yeast, bacteria or viruses and whether another disease is a possible trigger of chronic nail bed inflammation, different medications are used. If the inflammation has progressed to the point where fever occurs and the lymph nodes swell, antibiotics may also be prescribed. In the case of a yeast infection, antifungal ointments are also prescribed. Herpes viruses, on the other hand, can be treated well in the form of antivirals applied as ointments. Since nail bed inflammation is accompanied by pain and impairment of the function of the respective finger/toe, immobilization by small splints or elevation may often be necessary. If the nail bed inflammation is in an even more advanced stage, surgical intervention may also be considered. In this case, the physician opens the pus focus under anesthesia by either removing the nail completely or by creating an access through it. The pus located there is then drained and the wound is treated with a disinfecting ointment dressing. If a nail had to be removed for 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, the nail can be reduced in size during surgery. Since malposition of the foot can also lead to injuries and in the course of this to the disease of the nail bed, orthopedic inserts can also be prescribed. In rare cases associated with wound healing disorders and dead tissue, amputation is ultimately required to prevent the progression of infection.

Outlook and prognosis

The vast majority of acute nail bed infections are free of complications and heal completely on their own within a few days to weeks. In more severe cases, treatment with antibiotics may be necessary. If pus has accumulated under the nail and cannot drain away, it is necessary for a doctor to open the pus focus. Otherwise, the nail may detach, and in the worst case, even lead to 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 question of mistakes in nail care, which lead to small injuries, through which bacteria penetrate into the nail bed. The greatest risk factor is the removal of the protective cuticle, but ingrown nails can also cause inflammation of the nail bed. Contact with corrosive cleaning substances is also a possible cause. Appropriate protective measures should be taken here. If severe pain occurs, a doctor should be consulted. The prognosis is less favorable for chronically ill patients suffering from neurodermatitis or diabetes, because their immune system is weakened anyway. The dry skin causes cracks that can become inflamed. Severe courses, in which the inflammation can also spread to the surrounding tendons or even the bone, are rather rare and usually only seen in immunocompromised individuals.

Prevention

As a preventive measure, ensure that fingernails and toenails are trimmed regularly to counteract ingrowth or breakage. When filing, never go too deep into the lateral wall. Cuticles should also not be removed with scissors, but with a rounded pusher. 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.

Aftercare

Nail bed inflammation can undergo sustained regeneration through consistent aftercare. It is also not uncommon for a relapse to be prevented by targeted aftercare. 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 aftercare. Nail polish and nail polish remover also have irritation potential, which is why patients should avoid them. Torn nails can be treated both gently and professionally in foot care. If chemical exposure, for example at the workplace, is responsible for the nail bed inflammation, this is also an important issue in aftercare. Wearing gloves here, for example, is a measure that can possibly prevent the development of inflammation. This also applies to gardening, where soil in the area of the nail bed can also trigger inflammation or prevent inflammation from healing. If inflammations occur frequently, this can also be due to an immune deficiency or a diabetes disease. After clarification by the family doctor, it is then often also useful in the aftercare to strengthen the defenses of the affected person effectively and in the long term through a healthy diet, sufficient sleep and an adequate amount of drinking.

What you can do yourself

Measures to combat nail bed inflammation can be done by self-help in addition to treatment with medicines. So that the painful bacterial inflammation on fingernails or toenails can affect everyday life less, it should first be hygienically connected and thereby protected.On the one hand, this reduces the pain sensitivity to touch or impact. On the other hand, it can also prevent further contamination. Small injuries that had allowed bacteria to penetrate could otherwise continue to be a weak point. If it is a nail bed inflammation of a toe, no too tight footwear should be worn. The purulent inflammation can be treated with various options. Spreading clove oil or garlic broth is helpful. Likewise, a compress with arnica is useful. The affected foot or hand should also be bathed in warm water several times a day. This softens the horny layer and allows better drainage of pus. Bath additives such as chamomile and salt have an additional anti-inflammatory effect. The nail affected by nail bed inflammation can also be bathed in a lukewarm tea made from calendula flowers and rosemary. Dissolving two tablespoons of curd soap flakes per liter of water represents an old, proven home remedy for an inflamed nail bed. So is the nightly application of compresses with healing clay. The suppuration process can be promoted by silicea (silicic acid) in the case of nail bed inflammation.