The most common point of entry is a tiny, minor injury to the skin or the nail bed. As a result, bacteria enter the wound. The most common culprits are staphylococci and streptococci, which are naturally present on human skin. In children, mixed infections with oral bacteria 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 injury on the fingers from cutting nails, nail-biting, or manicures, nail bed infections can also occur on the toes. Here, shoes that are too tight, poor foot hygiene, and anatomical deformities of the toes are particular risk factors for nail bed infections.
Nail bed inflammation (panaritium) is acute in the majority of cases. Patients usually first complain of throbbing pain. The infected area of the nail is swollen and reddened. On the finger, nail bed inflammation often leads to an avoidance posture. On the toe, the pain usually makes it difficult to walk and to wear socks and shoes.
Nail bed infections are caused by fungi and bacteria that enter the skin through small injuries @ Roman Ivaschenko /AdobeStock
As the condition progresses, the nail bed infection begins to fester and, if left untreated, can spread to deeper layers of skin tissue. If the bacteria eventually reach the lymphatic system or the bloodstream, symptoms ranging from fever and chills to sepsis (“blood poisoning”) may occur.
If left untreated, severe forms of nail bed inflammation can lead to complications. These include, among other things, necrosis, in which parts of the affected tissue die off, as well as skin phlegmon. This is a purulent, diffusely spreading infection of the soft tissues, specifically the connective tissue. The inflammation can also spread to neighboring joints and tendons, leading to further restrictions in movement.
Depending on how deeply the nail bed inflammation has penetrated, medical professionals therefore distinguish between two main forms:
- superficial forms and
- deep forms.
Superficial nail bed infections include infections of the nail fold, the nail bed, and the subcutaneous fatty tissue. These are distinct from deep forms, which specifically involve the spread to bones, joints, and tendons.
The typical clinical presentation of a nail bed infection is already evident during the medical history. Swelling, redness, and pain in the area of the nail bed provide a clear clinical picture.
If a fever is present, a systemic course of the infection should be considered. The doctor will confirm this by evaluating inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, white blood cell count) in the blood.
Finally, an X-ray helps 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 a purulent nail bed infection, the doctor surgically opens and drains the wound site using a small incision. This is followed by antiseptic irrigation and the application of a dressing.
If, however, the nail bed infection is already more advanced, surgical treatment is almost always necessary. The procedure is then performed under local anesthesia, followed by an antiseptic irrigation of the wound. Depending on how far the infection has already penetrated into deeper tissue layers, an antibiotic may be necessary to prevent further spread of the bacterial pathogens. 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 within a few days to weeks. If the infection is already more advanced, it is important to treat it early; in that case, the nail bed inflammation will also heal without any lasting effects. The prognosis is somewhat worse in cases where the nail bed infection has already penetrated very deeply into underlying tissues, such as bone or tendons. In such cases, antibiotic therapy and a longer course of treatment are to be expected.
The prognosis is also less favorable for people with chronic comorbidities, such as those with allergies or diabetes. Atopic dermatitis or long-standing type 2 diabetes mellitus (“diabetes”) further weakens the immune system. This increases the risk of complications from a nail bed infection. Nevertheless, severe cases involving an infection that spreads to bones or tendons are very rare—in fact, they are typically found only in immunocompromised individuals.
First and foremost, you should make sure to trim your toenails and fingernails regularly. It’s best to avoid broken or ingrown nails altogether or correct them as soon as possible. When filing your nails, it’s important to be careful not to damage the nail fold. The cuticles, which often grow over the fingernail, are best removed with a rounded cuticle pusher rather than 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.
Since nail bed inflammation is, strictly speaking, a skin infection, dermatologists (specialists in dermatology) are the primary point of contact for treating this condition. If surgical treatment is necessary, surgeons (specialists in surgery) may also be consulted in addition to dermatologists.
What is a nail bed infection?
A nail bed infection is an inflammation of the tissue surrounding the nail. The infection often affects fingers or toes and is medically referred to as paronychia or panaritium. Depending on its course, a distinction is made between acute and chronic nail bed inflammation.
What are the symptoms of nail bed inflammation?
Typical symptoms of nail bed inflammation include redness, swelling, pus, and severe pain at the affected site. In addition, the skin around the nail may be inflamed and tender to the touch. In severe cases, systemic symptoms such as fever or swollen lymph nodes may occur.
What causes nail bed inflammation?
The most common causes of nail bed inflammation include minor injuries, ingrown nails, or poor nail care. Germs, bacteria such as Staphylococcus, fungi, or viruses can enter through the damaged skin and cause an infection. Diabetes or diabetes mellitus also increases the risk of nail bed inflammation.
How can nail bed inflammation be treated?
Treatment for nail bed inflammation depends on the severity and cause of the inflammation. Mild nail bed inflammation can often be treated with over-the-counter ointments, antiseptic ointments, or nail care products. In cases involving pus, subungual panaritium, or severe cases, antibiotics or surgery may be necessary.
How can you prevent nail bed inflammation?
To prevent nail bed inflammation, you should regularly care for your fingernails and toenails and avoid minor injuries. Good nail care and keeping the skin dry help keep pathogens at bay. It’s also important to treat ingrown nails early and keep the skin under the nail clean.
