Wound at the nail: what is the danger of paronychia in children

If you notice that your child has red­ness or swelling around the nail, they may have parony­chia. This fin­ger­nail infec­tion in chil­dren is a com­mon con­di­tion that can usu­al­ly be treat­ed at home. Learn more about the symp­toms and caus­es, and how to treat this inflam­ma­tion of the peri­un­gual fold in chil­dren.

What is paronychia?

Parony­chia is an infec­tion of the skin sur­round­ing the nail. Although in adults it can also affect the toes, in chil­dren it is usu­al­ly lim­it­ed to the hands. Parony­chia occurs around toe­nails only if the child has an ingrown toe­nail, which is quite rare and most­ly occurs in teenagers.

Inflam­ma­tion usu­al­ly devel­ops on the peri­un­gual roller, where the skin comes into con­tact with the nail on the side or at the base of the nail.

There are two types of parony­chia: acute and chron­ic.

An acute nail infec­tion occurs sud­den­ly and does not last long. Usu­al­ly appears only on the nails.

Chron­ic parony­chia can show up on a child’s fin­ger­nails or toe­nails and last longer. You may notice that the infec­tion either lasts a long time, or does not go away at all, or sub­sides and reap­pears.

Causes of paronychia

Parony­chia can devel­op in a child after some kind of injury or dam­age to the skin around the nail, cuti­cle, or nail fold (where the skin comes into con­tact with the nail). When this area is dam­aged, bac­te­ria and germs gain access to the tis­sues and can enter under the skin. In chil­dren, the most com­mon caus­es of ini­tial lesions around the nail are:

• Injury, such as a stuck splin­ter.
• Bit­ing nails or suck­ing, bit­ing or chew­ing on the skin around the nails.
• Break­ing off burrs.
• Trim­ming or push­ing back the cuti­cle.
• Man­i­cure.
• Too short cut nails, or if they are cut so that sharp cor­ners form.
• Ingrown nail.

In addi­tion to bac­te­ria, oth­er caus­es of parony­chia can be Can­di­da (a type of yeast) or fun­gi. More­over, it can be both a bac­te­r­i­al and a fun­gal infec­tion at the same time.

Fun­gal parony­chia can devel­op if a child has nail fun­gus or if their hands often come into con­tact with water.

Chron­ic parony­chia that keeps com­ing back can be caused by irri­tant der­mati­tis. It makes the baby’s skin red, itchy and irri­tat­ed. The irri­tat­ed skin can then be attacked by germs, caus­ing parony­chia.

Parony­chia usu­al­ly occurs on only one nail, not sev­er­al. Usu­al­ly the dis­ease begins to appear two to five days after the injury around the nail.

Symptoms of paronychia

The symp­toms of parony­chia are usu­al­ly easy to notice and rec­og­nize.

• The area around the nail, or the area of ​​the child’s orig­i­nal injury, usu­al­ly becomes red and swollen.
• The child him­self will prob­a­bly say that the fin­ger hurts or is sen­si­tive.
• When you touch the infect­ed area, you can feel that it is warmer than the sur­round­ing areas.
• In some cas­es, if the cause is a bac­te­r­i­al infec­tion, a pus-filled blis­ter forms at the site of inflam­ma­tion.

You may notice that the nail also looks dif­fer­ent. It may have a strange col­or or shape, or it may start to look like it has come off the skin. If the nail infec­tion is bac­te­r­i­al, these changes hap­pen more quick­ly. Fun­gal infec­tions take longer to devel­op symp­toms.

Why is parony­chia dan­ger­ous? This is a spe­cial case of panari­tium, a more exten­sive inflam­ma­to­ry process. When the nail infec­tion spreads to oth­er parts of the body, the child may show signs of a dan­ger­ous sys­temic infec­tion. These include:

• Chills.
• Heat.
• Pain in mus­cles or joints.
• Red streaks on the skin.
• Gen­er­al malaise.

Treatment of nail infection at home

Treat­ment for parony­chia depends on how severe the infec­tion is. In most chil­dren, fin­ger­nail infec­tions can be treat­ed at home and no spe­cial treat­ment is need­ed.

Home care. To treat parony­chia at home, “soak” your child’s fin­ger in warm salt water sev­er­al times a day. Each pro­ce­dure should last from 10 to 20 min­utes. After the bath, dry your fin­ger with a clean tow­el. If you notice any flu­id drip­ping from the infec­tion site, clean it care­ful­ly.

If the child is uncom­fort­able or com­plains of pain, check with the doc­tor — as a rule, in such cas­es, a com­mon pain reliev­er such as ibupro­fen or parac­eta­mol is pre­scribed.

While you are treat­ing your child’s infec­tion, remind him to leave the area alone. This means not bit­ing the nail or chew­ing on the skin around it, as this can be the cause of the ini­tial infec­tion.

While parony­chia is heal­ing, take care of your child’s nails by trim­ming them week­ly. Sub­se­quent­ly, the child’s nails need to be trimmed less often. Keep them smooth so that the edge of the nail is not sharp or uneven, and don’t cut the nail too short.

With this approach, the nail infec­tion should go away on its own with­in a few days.

When to see a doctor?

While most cas­es of parony­chia are mild and resolve with home treat­ment, some cas­es may need to see a doc­tor. For exam­ple, if the infec­tion per­sists after one week of home treat­ments, a spe­cial­ist con­sul­ta­tion is need­ed. Not only will it help get rid of the infec­tion, but it will also ensure that the infec­tion does not spread to oth­er parts of the child’s body.

If you notice that an abscess or accu­mu­la­tion of pus has formed around your child’s fin­ger, a doc­tor will need to drain it. After drainage, the infect­ed toe usu­al­ly heals fair­ly quick­ly and with­out com­pli­ca­tions. In some rare cas­es, it may be nec­es­sary to remove part of the nail: accord­ing to a study by doc­tors from the Kar­pogo­ry Cen­tral Dis­trict Hos­pi­tal, almost one in three patients who vis­it a doc­tor with parony­chia require surgery.

To make sure the child’s infec­tion is gone, the doc­tor may pre­scribe a course of antibi­otics. In this case, it is impor­tant that the child com­pletes the entire course of treat­ment. The doc­tor may also pre­scribe a steroid cream to apply to the inflamed area to help with heal­ing.

If the doc­tor thinks the infec­tion is caused by a fun­gus, he or she will pre­scribe anti­fun­gal drugs. It can be an oral med­ica­tion, cream or oint­ment.

If your child has chron­ic parony­chia, keep their hands and nails clean and dry, and stay away from any harsh chem­i­cals that can irri­tate the skin. To keep your child’s hands dry, you can ask them to wear gloves when in con­tact with water, or to apply a dry­ing cream as the infec­tion heals.

Parony­chia with­out treat­ment often turns into panari­tium. Read about this pathol­o­gy in the arti­cle “Panari­tium: caus­es and symp­toms of inflam­ma­tion.”