Symptoms depend on whether paronychia of the nail unit is acute or chronic.

Acute paronychia of the nail unit often presents with:

• Rapid onset redness, swelling, and tenderness around the nail fold
• Warmth and throbbing pain at the edge of the nail
• Pus or a visible abscess, sometimes with pressure and fluctuance

Chronic paronychia of the nail unit more commonly includes:

• Persistent swelling and irritation of the nail folds lasting weeks to months
• Loss of the cuticle seal, with recurrent inflammation after wet work
• Nail changes such as ridging, waviness, or brittleness over time

Because painful nail-fold swelling can overlap with other conditions (such as herpetic whitlow or deeper fingertip infections), persistent or severe symptoms merit prompt evaluation.

Paronychia of the nail unit usually begins when the protective barrier at the nail fold is disrupted, allowing inflammation and microbes to enter.

Common contributors include:

• Trauma to the cuticle or nail fold, including hangnails, nail biting, picking, manicures, or trimming the cuticle
• Frequent moisture exposure (handwashing, dishwashing, cleaning, food handling), which can weaken the nail-fold barrier and promote chronic inflammation
• Acute bacterial infection, commonly following a break in the skin
• Chronic irritant dermatitis, with possible secondary yeast (Candida) colonization in some cases

Chronic paronychia is frequently described as a dermatitis-driven condition rather than a primary fungal infection, which affects treatment selection.

Diagnosis is typically clinical and is based on:

• Location of inflammation in the proximal or lateral nail folds
• Timing and course (sudden onset versus persistent disease)
• Evidence of abscess (pus collection) in acute cases

In recurrent, severe, or atypical cases, evaluation may include:

• Assessment for exposures such as wet work and irritants
• Review of manicure habits and cuticle care
• Consideration of culture when drainage is present or response to therapy is incomplete (to guide targeted treatment)

Dr. Knackstedt and the Peak Skin Center team also assess for complications, including deeper infection or nail-matrix involvement that can affect nail growth.

Treatment is guided by whether paronychia of the nail unit is acute or chronic and whether an abscess is present.

Acute paronychia of the nail unit

When an abscess is present, incision and drainage is a core treatment to relieve pressure and remove pus. Clinical guidance notes that drainage is often the key intervention and that oral antibiotics are not necessarily superior to drainage alone in uncomplicated cases.

Common management steps may include:

• Warm soaks several times daily to reduce inflammation and promote drainage
• Topical antibiotics for localized infection without significant abscess
• Oral antibiotics when cellulitis is present, symptoms are significant, or risk factors warrant systemic therapy
• Incision and drainage when pus has collected (abscess)

Chronic paronychia of the nail unit

Chronic paronychia management focuses on restoring the nail-fold barrier and reducing dermatitis triggers. Avoidance of irritants and moisture exposure is frequently emphasized.

Treatment options may include:

• Protection from wet work and irritants, including glove strategies and barrier protection
• Topical corticosteroid ointment for 2–4 weeks, with repeat courses for flares
• Topical tacrolimus as an alternative when dermatitis is resistant to routine management
• Antiseptics and, when Candida is confirmed, antifungal therapies (topical and sometimes oral)