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Nail bed inflammation: cause, symptoms, treatment

by Josephine Andrews
Published: Last Updated on 353 views

Nail bed inflammation is inflammation of the skin under the nail. It can also spread to the nail wall. Redness, itching and pain, and pus that collects under the nail are common symptoms of acute nail bed inflammation. Read more about the topic: How do you recognize nail bed inflammation? What to do about the inflammation? What are the chances of recovery?

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

L03

Nail bed inflammation: description

Nail bed inflammation is a mostly bacterial infection of the nail bed. The nail bed is the tissue on which the nail plate rests—that is, the area just below a nail. In general, nail bed inflammation can affect toenails and fingernails alike. The infection is quite common – nail bed infections account for around 30 percent of all infections affecting 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 last term expresses that the inflammation 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 – there do not have to be any special risk factors for this.

If the inflammation keeps recurring despite treatment, doctors speak of chronic nail bed inflammation . It mostly affects people whose immune system is weakened due to a chronic disease (such as diabetes mellitus) or who repeatedly come into contact with substances that damage the skin . For the therapy it is important that not only the nail bed inflammation is treated – if possible the favorable factors are also addressed.

Nail bed inflammation: symptoms

If the nail bed is acutely inflamed, this is usually first shown by severe reddening of the affected skin areas. Especially in the initial phase of the nail bed inflammation, the skin around the nail itches. Then the skin area swells and shines reddish. Local overheating is also a classic sign of inflammation.

Other symptoms may include moderate to severe pain. At first they only appear under pressure. The affected fingers or toes start to hurt after just a few days without being exposed to any irritation. At the latest when severe pain occurs without pressure stimulus, a doctor should be consulted.

Typically, subungual panaritium collects pus under the nail over the course of several days. This purulent swelling usually causes severe pain and can cause the nail plate to separate from the nail bed. Sometimes the accumulation of pus bursts on its own – the pus then drains out over the side edges of the nail. If the collection of pus does not open on its own, it may be necessary to open it surgically.

If nail bed inflammation is left untreated for a long time, nail growth may be disrupted.

Chronic nail bed inflammation

Acute nail bed inflammation can develop into chronic. This usually happens when there are other risk factors, such as an ingrown toenail. Chronic nail bed inflammation is usually less painful than an acute one. The nail plate can be discolored yellowish or greenish. Another difference to the acute form: chronic onychia usually affects several nails and not just one finger or toenail alone.

Nail bed inflammation: causes and risk factors

The most common pathogens causing nail bed inflammation are bacteria of the Staphylococcus type. Rarer are other bacteria or fungi or viruses (yeast fungi, herpes viruses) the trigger of the inflammation.

These pathogens do not cause any damage to healthy skin. The pathogens can only penetrate the skin and cause acute inflammation via small wounds located on the nail fold, the skin or the nail wall. The small wounds are mostly minor injuries, such as those caused by nail care. Ingrown nails and intense skin irritation (eg due to cleaning agents) can also create entry points for pathogens.

Acute nail bed inflammation mostly affects women who practice excessive or incorrect nail care. People with dry skin are also more likely to have nail bed infections. Also at risk are people with chronic neurodermatitis or diabetes mellitus and people with circulatory disorders. Other risk groups are people with a weakened immune system and cancer patients who receive therapy with so-called EGFR agonists or tyrokinase inhibitors.

Nail bed inflammation: investigations and diagnosis

You don’t have to go to the doctor immediately with every nail bed infection! With a healthy immune system and no other illnesses, you can wait a few days – the inflammation often heals on its own. However, you should go to a doctor at the latest if there is no improvement within three days or if the symptoms rapidly worsen. People who are known to have a weakened immune system should consult a doctor at even the slightest sign of inflammation.

The right contact person for a (suspected) nail bed infection is the general practitioner or a dermatologist.

anamnese

In an initial consultation, the doctor will take your medical history (anamnesis). To do this, he lets you describe the nature and course of your complaints in detail. He can 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)?

investigations

physical examination follows the anamnesis. The doctor examines the affected skin in detail. By palpating, he determines whether there is pain. In most cases, the obviously visible symptoms of nail bed inflammation are sufficient to make an initial diagnosis.

In order to confirm the diagnosis and to differentiate the skin changes from, for example, squamous cell carcinoma (type of skin cancer), the doctor takes a swab from the inflamed skin areas. Under the microscope, it is possible to see which type of pathogen is responsible for the infection (such as bacteria, fungi). In order to determine the exact germ of the disease, a culture of the smear can be created in the laboratory. However, the evaluation of such a culture takes one to several weeks.

Nail bed inflammation: treatment

Depending on the stage of the nail bed inflammation, the treatment can be carried out by the patient himself or by a doctor. In the early stages of inflammation (signs of inflammation for less than three days), you can try to treat nail bed inflammation yourself. However, if there is no improvement, medical treatment is necessary. It is advisable from the start if you have risk factors for a difficult course (eg weakened immune system).

Treat nail bed inflammation yourself

There are several ways to treat nail bed inflammation yourself. First, you should bathe the affected foot or finger in warm water several times a day . This softens the callus and makes it easier for accumulated pus to drain. Additives such as chamomile support the healing effect.

After such a bath, you should apply a disinfectant solution . Some patients bandage the finger or toe in such a way that it can no longer be moved at first – the immobilisation supports the healing process.

Several over-the- counter medications for nail bed inflammation are available in pharmacies. When choosing a suitable preparation, however, in many cases you have to know which pathogens are responsible for the inflammation. For example, the active ingredients naftifine and nystatin are antifungals – 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, you should avoid such targeted medication.

A drug that is generally effective against germs on the skin is burn and wound gel . It contains the active ingredients benzethonium chloride, urea and polidocanol. Another remedy for multiple types of germs is povidone iodine . It is the most commonly used remedy for nail bed inflammation. Ointment, gel or cream with povidone iodine has a disinfecting effect.

On heavily suppurating areas you can apply ammonium bituminosulfonate – a general anti-inflammatory agent that is also effective against bacteria and fungi. It is available in pharmacies as a tincture or ointment. An ointment with ammonium bituminosulfonate is also called a traction ointment. Nail bed inflammation and other skin inflammations and diseases can sometimes be treated successfully with it. In some cases, however, the anti-inflammatory effect of the traction ointment is too low. However, 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 chamomile, 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 of these home remedies only provide relief for minor inflammations and cannot replace necessary medical therapy. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Medical panaritium treatment

In the initial stage of the inflammation, the doctor also tries to treat the nail bed inflammation purely externally with antiseptic agents. If the inflammation is very extensive or if there is severe pain, additional therapy with antibiotics is carried out. In this case, active ingredients from the class of penicillins are mainly prescribed. These help particularly well against staphylococci – the main cause of nail bed inflammation.

If nail bed inflammation does not subside after several weeks, an X-ray is used to determine whether the inflammation has already spread to surrounding structures.

Surgical intervention may be advisable in the case of extensive nail bed inflammation and 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 size of the surgical procedure, it takes one to several weeks for the wound to heal completely.

Chronic nail bed inflammation

In the case of chronic inflammation of the nail bed, which shows no improvement despite repeated therapy, the doctor will try to determine the triggering factors. If the recurring nail bed inflammation is based on a chronic disease, it must be treated primarily. In cases where frequent handling of harsh substances or cleaning agents causes subungual (or parungual) panaritium, these risk factors must be eliminated.

Nail bed inflammation: course and prognosis

The course and prognosis of onychia and paronychia depend on the severity of the infection and when treatment is started. If an inflamed nail bed is not treated, the inflammation may continue to spread. It can also spread from the skin to the tendon sheaths that surround the finger and toe joints, and from there even to the bones. Inflammation of the tendon sheaths (tendovaginitis) or bones (osteomyelitis) is very painful and often requires quite a long treatment.

If nail bed inflammation is treated properly, it usually heals completely within a few days. It is important to ensure that no irritants get onto the inflamed skin.

Nail bed inflammation: prevention

The main way to prevent nail bed inflammation is to take good care of your nails. If you have dry and cracked skin around the nail bed, you should use a greasy cream and also apply cream to your nails regularly.

Do not cut off the edges of the toenails, as this encourages the nail to grow in. When caring for your nails, be careful not to injure 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 the nails are exposed to heavy loads in everyday life, you should ensure appropriate protection. For example, wear gloves if you often come into contact with sharp substances or strong cleaning agents. To protect your toenails, you should only wear shoes that give your feet enough space and sweat as little as possible. These measures reduce the risk of nail bed inflammation .

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