I showed my two eldest (who are fingernail biters/pickers, much to my dismay) this lovely picture of a patient who I saw this week. I also outlined the gory details of treating the complications that arise from biting and picking your nails. While I don’t normally employ the scare tactic (not my parenting style typically), I decided enough was enough with my nail pickers. I think they were sufficiently horrified by the time I finished talking to them. At least they may think twice before continuing their little habit (see NAIL BITING: HOW TO BREAK THE DIRTY LITTLE HABIT).

This picture is a classic picture of a paronychia, or fingernail infection. It is relatively common (I see one every week or two). Paronychias are infections of the skin around the nails (usually fingernails, but can be toenails). The infected area becomes red, painful, swollen, and often filled with pus (just like the picture).

What causes paronychias?

1. Biting or picking the fingernails and surrounding skin (like hangnails or cuticles)
2. Sucking on the fingers
3. Cutting nails too short
4. Trimming the cuticle
5. Bad manicures
6. Trauma to the skin (cuts, slivers, etc.)
7. Chronic diseases (e.g., diabetes)

How to treat it

1. Home remedies. Mild cases may be treated at home (in the picture here, you can see infection in the index and ring fingers). The home remedies involve soaking in warm water (adding Epsom salts helps reduce the swelling) for 15-30 mins, 2-3 times a day. Then apply topical antibiotic ointment (like a Polysporin) after the soaks.
2. Doctor’s office for the more serious cases (in my pic, the middle finger). If the infection is rapidly spreading or getting worse, more aggressive treatment is required.
   1. The cases with abscesses (the pus-filled pocket) will often require drainage. Usually doctors will obtain a culture of the pus to see which bacteria grow (which helps guide treatment).
   2. Antibiotics are often used in these cases as well, either oral, topical or both. Your doctor will help guide which treatment option is the most appropriate.

Paronychias prevention

It is very easy to talk about how to prevent paronychias. The practical application is quite another story (believe me, I know from personal experience).

1. Stop biting or picking nails.
2. Use fingernail clippers instead to clip nails (just above the where the white growth of the nail is).
3. Don’t trim cuticles.
4. Keep skin and area around nails (including cuticles) moist and well cared for. Compromised, dry/cracking skin is more likely to get infected.
5. Keep chronic conditions in check , as much as possible (e.g., good sugar control in diabetes).

Special thanks to my patient’s wonderful mom who let me snap a pic for you all to see.