Nail bed inflammation (panaritium) is a mostly harmless but very painful infection of the nail bed on fingers or toes. The most common bacterial pathogensof nail bed inflammation are staphylococci. As a rule, purulent inflammation of the nail bed only affects the superficial areas. However, if left untreated, it can also lead to a systemic infection and even sepsis ("blood poisoning").
Nail bed inflammation is probably the most common disease of the fingers. Even the smallest injury, e.g. through a cut or when cutting fingernails, can make it easier for bacteria and fungi to penetrate the skin.
The most common entry points are the smallest minor injuries to the skin and the nail bed. As a result, bacteria penetrate the wound. The most common bacteria are staphylococci and streptococci, which are found on human skin. In children, mixed infections with oral germs occur more frequently due to nail biting. However, the route of infection for nail bed inflammation is usually direct, local infection.
In addition to the risk of nail bed injuries on the fingers when cutting nails, biting nails or during manicures, nail bed infections can also occuron the toes. Shoes that are too tight, poor foot hygiene and anatomical misalignment of the toes are particular risk factors for nail bed inflammation.
Nail bed inflammation (panaritium) occurs acutely in the majority of cases. Patients usually first complain of pulsating pain. The infected area on the nail is swollen and reddened. On the finger, nail bed inflammation often leads to a relieving posture. On the toe, the pain usually interferes with walking and wearing socks and shoes.
Nail bed inflammation is triggered by fungi and bacteria that enter the skin via small injuries @ Roman Ivaschenko /AdobeStock
As the inflammation of the nail bed progresses, it begins to fester and can then penetrate into deeper tissue layers of the skin if left untreated. If the bacteria finally reach the lymphatic system or the blood, fever and chills and even sepsis ("blood poisoning") occur.
If left untreated, severe forms of nail bed inflammation can lead to complications. These include necrosis, in which parts of the affected tissue die off, and phlegmon of the skin. This is a purulent, diffusely spreading infection of the soft tissue, the so-called connective tissue. The inflammation can also spread to neighboring joints and tendons, which leads to further movement restrictions.
Depending on the depth of penetration of the nail bed inflammation, doctors therefore distinguish between two different main forms:
Superficial nail bed inflammation includes infections of the nail wall, the nail bed and the subcutaneous fatty tissue. A distinction must be made between deep forms, which include in particular the spread to bones, joints and tendons.
The typical appearance of nail bed inflammation is already noticeable in the medical history. The swelling, redness and pain symptoms in the area of the nail bed provide a clear clinical diagnosis.
If fever occurs, a systemic course of the infection should be considered. The doctor will clarify this using the inflammation parameters (C-reactive protein, erythrocyte sedimentation rate, leukocyte count) in the blood.
Finally, an X-ray will help to determine whether the nail bed inflammation has already spread to the bones and joints.
In the case of a superficial infection, it is usually sufficient to immobilize the affected area on the finger or toe. In the case of purulent nail bed inflammation, the doctor opens and drains the wound site surgically using a small incision. This is followed by antiseptic rinsing and a dressing.
However, if the nail bed inflammation is already more advanced, surgical treatment is almost always necessary. The procedure is then performed under local anesthesia and followed by antiseptic rinsing of the wound. Depending on how far the infection has already penetrated into deeper layers of tissue, an antibiotic may be necessary to prevent the bacterial pathogens from spreading further. In any case, the affected finger or toe is immobilized after the wound has been treated.
As a rule, nail bed inflammation is purely superficial and usually heals on its own after a few days to weeks. If the infection is already more advanced, it is important to treat it at an early stage, then the nail bed inflammation will also heal without consequences. The prognosis is somewhat worse in cases where the nail bed inflammation has already penetrated very far into deeper tissue, e.g. bones or tendons. In this case, antibiotic therapy and a longer course of treatment are to be expected.
The further prognosis is alsounfavorable for people with chronic concomitant diseases, such as allergy sufferers or diabetics. Atopic dermatitis or long-term type 2 diabetes mellitus ("diabetes") further weakens the immune system. This increases the risk of complications from nail bed inflammation. Nevertheless, severe courses with an infection spreading to bones or tendons are very rare - in fact, they are only found in immunocompromised patients.
First and foremost, you should make sure that you cut your toenails and fingernails regularly. It is best to avoid broken nails or ingrown nails altogether or correct them as quickly as possible. When filing nails, it is important to take care not to damage the nail wall. Cuticles that often grow over the fingernail are best removed with a rounded scraper and not with nail scissors.
Regular foot and hand care with moisturizing creams and oils should be part of your daily routine. This is the only way to keep the skin on your fingers and toes supple and prevent cracks and dry patches of skin.
As nail bed inflammation is an infection of the skin in the narrower sense, dermatologists (specialists in dermatology) are the first point of contact for treating the condition. If surgical treatment is necessary, doctors specializing in surgery (specialists in surgery) can also be consulted in addition to dermatologists.
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