Winter weather can be hard on hands. The drop in temperature and humidity strips moisture from the skin, leaving knuckles and fingertips dry and irritated. Routine hand-washing further compromises the skin’s protective barrier by depleting its natural oils. The thin, delicate skin around fingernails is especially prone to drying and splitting, making it vulnerable to infection.
A cracked cuticle can become a breeding ground for bacteria, which may result in a paronychia (păr′ə-nĭk′ē-ə), one of the most common hand infections in the U.S.
Paronychia — “beside the nail,” in Greek — start as inflammation of the soft tissue bordering the fingernail. (Toes can be affected too, but neglected ingrown nails are by far more common.) They can be acute or chronic. An acute paronychia appears suddenly and usually involves only one finger. The skin and cuticle become red, hot, swollen, and throbbingly painful. The majority are caused by Staphylococcus aureus bacteria — commonly referred to as a staph infection. With simple, early home treatment, an acute paronychia often resolves in less than 10 days. But if ignored, an abscess can form alongside the nail; rarely, the infection can spread to the rest of the hand (cellulitis), which quickly becomes a medical emergency.
Chronic paronychia takes more than six weeks to develop, and usually affects multiple fingers. Skin bordering the nails gradually becomes inflamed, tender, and puffy. Unlike an acute infection, chronic paronychia is actually a type of skin irritation (contact dermatitis), the result of long-term exposure to workplace chemicals. It often develops a fungal overgrowth, usually with Candida albacans, and lasts for months — even with treatment.
Nail biting, hangnails, and frequent manicures increase the chances of developing an acute paronychia. Occupations involving wet work, like bartending and dishwashing, also raise the risk. Chronic paronychia is a job hazard for professionals frequently exposed to detergents and chemical irritants, including health care workers, custodians, and hairdressers. It is also more common in those with a weakened immune system from diseases like diabetes, eczema, or cancer.
If you notice redness and swelling alongside one fingernail, soak your finger in 8 ounces of equal parts warm water and white vinegar for 15 minutes three times daily until it resolves. The heat of the water improves circulation and brings immune cells to fight the bacterial infection; the vinegar’s acidity can reduce pain and inflammation. If symptoms persist or an abscess forms — a common complication of an acute paronychia — contact your primary care provider: Oral antibiotics or a minor in-office surgical procedure to drain any pus may be needed. Chronic paronychia is treated with prescription topical steroid cream and oral antifungal medication. See your clinician if more than one finger is inflamed.
Paronychia can be prevented by practicing good nail hygiene: Avoid biting, chewing, and picking your fingernails, and don’t trim cuticles during a manicure. Wear cotton-lined waterproof gloves when working with detergents or chemical irritants. Moisturize your hands regularly (especially after washing them) with a nongreasy cream such as Norwegian Formula or CeraVe Therapeutic ward off chapped, cracked skin.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state