Inflammation of the nail bed: Description
Nail bed inflammation is usually a bacterial infection of the nail bed. The nail bed is the tissue on which the nail plate rests – i.e. the area directly under a nail. In general, nail bed inflammation can affect both toenails and fingernails. The infection is quite common – nail bed inflammation accounts for around 30 percent of all infections that affect the hand.
Doctors also refer to nail bed inflammation as onychia or panaritium subunguale (from the Latin “sub” = under and “ungus” = nail). Sometimes the inflammation also spreads to the nail wall (= tissue area around the nail plate). Then it is a panaritium parunguale – also called paronychia or “circulation”. The latter term expresses the fact that the inflammation virtually runs around the nail.
Acute and chronic nail bed inflammation
Depending on the course, a distinction is made between chronic and acute nail bed inflammation:
Anyone can develop acute nail bed inflammation – no special risk factors need to be present.
Nail bed inflammation: symptoms
If the nail bed is acutely inflamed, this is usually initially manifested by severe reddening of the affected areas of skin. Particularly in the initial phase of nail bed inflammation, the skin around the nail itches. The area of skin then swells and has a reddish sheen. Localized overheating is also a classic sign of inflammation.
Other symptoms may include moderate to severe pain. Initially, this only occurs when pressure is applied. After just a few days, however, the affected fingers or toes also hurt without being exposed to irritation. A doctor should be consulted at the latest when severe pain occurs without a pressure stimulus.
In a subungual panaritium, pus typically accumulates under the nail over the course of several days. This purulent swelling usually causes severe pain and can cause the nail plate to detach from the nail bed. Sometimes the accumulation of pus bursts open on its own – the pus then drains over the side edges of the nail. If the accumulation of pus does not open on its own, it may be necessary to open it surgically.
If nail bed inflammation remains untreated for a long time, the growth of the nail may be impaired.
Chronic nail bed inflammation
Nail bed inflammation: causes and risk factors
The most common pathogens causing nail bed inflammation are bacteria of the staphylococcus type. Other bacteria or fungi or viruses (yeasts, herpes viruses) are less common triggers of the inflammation.
These pathogens do not cause any damage on healthy skin. The pathogens can only penetrate the skin and cause acute inflammation through small wounds on the nail fold, the skin or the nail wall. The small wounds are usually minor injuries, such as those that occur during nail care. Ingrown nails and intense skin irritation (e.g. caused by cleaning agents and detergents) can also create entry points for pathogens.
Acute nail bed inflammation usually affects women who practice excessive or incorrect nail care. People with dry skin are also more likely to suffer from nail bed inflammation. People with chronic neurodermatitis or diabetes mellitus and people with circulatory disorders are also at risk. Other risk groups include people with a weakened immune system and cancer patients who are receiving treatment with EGFR agonists or tyrokinase inhibitors.
Nail bed inflammation: examinations and diagnosis
The right contact person for (suspected) nail bed inflammation is your family doctor or a dermatologist.
Medical history
In an initial consultation, the doctor will take your medical history (anamnesis). He or she will ask you to describe the nature and course of your symptoms in detail. He may also ask the following questions, for example
- Do you often suffer from such complaints?
- What do you do for a living?
- Do you have any known allergies?
- Do you have any pre-existing conditions (such as diabetes)?
Examinations
The medical history is followed by a physical examination. The doctor will examine the affected areas of skin in detail. By palpation, he determines whether there is any pain. In most cases, the obvious symptoms of nail bed inflammation are sufficient to make an initial diagnosis.
To confirm the diagnosis and differentiate the skin changes from squamous cell carcinoma (a form of skin cancer), for example, the doctor takes a swab from the inflamed areas of skin. Under the microscope, the type of pathogen responsible for the infection (such as bacteria or fungi) can be identified. In order to determine the exact pathogen, a culture of the swab can be taken in the laboratory. However, the analysis of such a culture takes one to several weeks.
Nail bed inflammation: Treatment
Treating nail bed inflammation yourself
There are various ways to treat nail bed inflammation yourself. Firstly, you should soak the affected foot or finger in warm water several times a day. This softens the callus and makes it easier for the accumulated pus to drain away. Additives such as camomile support the healing effect.
After such a bath, you should apply a disinfectant solution. Some patients bandage their finger or toe so that it cannot be moved for the time being – immobilization supports the healing process.
Several over-the-counter medications for nail bed inflammation are available in pharmacies. However, when choosing a suitable preparation, it is often necessary to know which pathogens are responsible for the inflammation. For example, the active ingredients naftifine and nystatin are antimycotics – they only work against fungal infections. They do not help with bacterial infections. If you do not know which pathogens are responsible for your nail bed inflammation, it is better to avoid such targeted medication.
You can apply ammonium bituminosulphonate – a general anti-inflammatory agent that is also effective against bacteria and fungi – to heavily suppurating areas. It is available as a tincture or ointment from pharmacies. An ointment with ammonium bituminosulphonate is also known as a traction ointment. Nail bed inflammation and other skin inflammations and diseases can sometimes be successfully treated with it. In some cases, however, the anti-inflammatory effect of the traction ointment is too weak. Treatment methods with stronger active ingredients can only be prescribed by a doctor.
Nail bed inflammation: Home remedies
Home remedies for nail bed inflammation are primarily natural substances such as camomile, arnica or savoy cabbage. They have an anti-inflammatory effect. Onion extract, horseradish and tea tree oil are also used to treat nail bed inflammation.
Home remedies have their limits. All these home remedies only provide relief for mild inflammation and cannot replace the need for medical treatment. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
Medical panaritium treatment
If an inflammation of the nail bed does not subside after several weeks, an X-ray is taken to determine whether the inflammation has already spread to surrounding structures.
Surgical intervention may be advisable in the case of extensive nail bed inflammation or a persistent accumulation of pus. The doctor removes the accumulation of pus or severely affected tissue under local anesthesia. After the procedure, the affected hand or foot is immobilized. Depending on the extent of the surgical procedure, it may take one to several weeks for the wound to heal completely.
Chronic nail bed inflammation
In the case of chronic nail bed inflammation, where there is no improvement despite repeated treatment, the doctor will try to determine the triggering factors. If the recurring nail bed inflammation is caused by a chronic disease, this must be treated primarily. In cases where frequent contact with harsh substances or cleaning agents causes subungual (or parungual) panaritium, these risk factors must be eliminated.
Nail bed inflammation: course and prognosis
If nail bed inflammation is treated correctly, it usually heals completely within a few days. It is important to ensure that no irritants are applied to the inflamed skin.
Nail bed inflammation: prevention
You can primarily prevent nail bed inflammation by taking good care of your nails. If the skin around the nail bed is dry and cracked, you should use an oily cream and apply cream to your nails regularly.
Do not cut the edges of the toenail round, as this encourages the nail to grow in. When caring for your nails, make sure you do not damage the surrounding skin. If you have very soft and brittle nails, you may be able to strengthen your nails with magnesium and folic acid tablets – ask your doctor or pharmacist for advice.
If your nails are exposed to a lot of stress in everyday life, you should ensure they are properly protected. For example, wear gloves if you often come into contact with aggressive substances or strong cleaning agents. To protect your toenails, you should only wear shoes in which your feet have enough room and sweat as little as possible. These measures reduce the risk of nail bed inflammation.
