Skip to main content
Foot Ankle Lower Limb — foot and ankle surgery and podiatry, Perth

Skin and nailsGuide

Paronychia (infected nail fold)

Paronychia is a red, swollen, sore nail fold: the skin around a fingernail or toenail, often after a small injury. Mild early cases usually start with warm soaks. Pus, worsening redness or pain, or a problem lasting more than 6 weeks needs a GP or podiatrist.

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPodLast reviewed 27 October 2026 6 min read

Jump to a section
  1. 1. What is paronychia, and how common is it?
  2. 2. What causes it, and who gets it?
  3. 3. What does it feel like, and how is it diagnosed?
  4. 4. What helps first?
  5. 5. What helps if that isn't enough?
  6. 6. How long does it take, and how do I stop it coming back?
  7. 7. When to see a podiatrist

At a glance

  • It's a sore, swollen nail fold: the skin around a fingernail or toenail becomes red and tender, often after a small injury.
  • Warm soaks are the usual first step for a mild, early case.
  • Pus or worsening infection needs a clinician, and may need draining or antibiotics.
  • Lasting more than 6 weeks is different and needs a GP or dermatologist (skin doctor) to review it.
  • Diabetes or poor circulation: a toenail or foot problem needs a GP or podiatrist the same day.

What is paronychia, and how common is it?

Paronychia is inflammation of the nail fold (the skin and soft tissue that frames and supports the nail) around a fingernail or toenail. It's often caused by infection, injury or irritation. It's described as acute (starting suddenly) or chronic (long-lasting).

It typically starts when the seal between the nail and the nail fold breaks down, which lets germs in. The nail area is the most common place for infections in the hand. You may also hear it called a nail fold infection.

What causes it, and who gets it?

A knock or injury to the cuticle or nail fold is the usual trigger. On the fingers, common starting points are nail biting, manicures and household wet work. Artificial nails and nail polish may also play a part. On the toes, it mostly happens with an ingrown toenail.

Sudden (acute) paronychia is usually caused by bacteria from the skin getting into the nail fold. Long-lasting (chronic) paronychia is linked with loss of the cuticle. It can also have other causes, such as a skin condition, a yeast or a fungus, rather than bacteria.

Adults taking a type of cancer medicine called an EGFR inhibitor can develop paronychia, usually 1–6 months after starting. If that's you, tell your medical team at the first sign of nail changes, because a mild problem can worsen quickly.

What does it feel like, and how is it diagnosed?

The nail fold looks swollen and red, and it's tender and feels warm. Pus may form under the skin beside the nail. On a toe, the pain can be on all sides and on top of the nail. Sudden paronychia usually appears 2–5 days after the trigger, most often in one finger or toe.

Chronic paronychia lasts more than 6 weeks, usually affects more than one fingernail, comes on more gradually and is less painful. The nail may thicken, ridge or change colour.

A podiatrist or GP will ask how long it has been there, how many nails are involved and what might have started it, then look for pus or nail changes.

Some other problems can look similar. A viral infection called herpetic whitlow causes small grouped blisters rather than a pocket of pus, and it shouldn't be drained. Other skin conditions can also cause it, particularly when several fingers or toes are involved or the nails change in a typical way. That's why it's worth having a clinician look before anyone drains or cuts into it.

What helps first?

For a mild, early case, warm soaks are the usual first step. A podiatrist or GP can add an antibiotic cream, sometimes with a steroid cream, if soaks alone don't settle the inflammation. If a pocket of pus forms, a clinician may need to drain it.

For a child's finger, soaking in warm salted water four times a day often clears the infection in a few days, and a pharmacist can advise on pain relief such as paracetamol.

What helps if that isn't enough?

If it isn't settling, see your GP, who has other treatment options. Suspected chronic paronychia should be seen by a dermatologist, and one that doesn't respond to standard treatment should be investigated for unusual causes. Steroid creams are the main treatment for chronic paronychia, and a doctor decides whether they suit you.

If it comes with an ingrown toenail, the nail is part of the problem, so a podiatrist should assess it. Antibiotic tablets aren't used routinely unless infection is proven. An infected ingrown nail needs an antibiotic and prompt referral.

If you take an EGFR inhibitor and the nail problem is getting worse, your cancer team decides about the medicine and may refer you to a dermatologist or podiatrist.

How long does it take, and how do I stop it coming back?

With treatment, an infected nail fold can clear up in a few days. If it hasn't settled in that time, or it returns, see your GP or a podiatrist. Chronic paronychia takes longer, since by definition it has lasted more than 6 weeks.

To lower the chance of a repeat, it makes sense to avoid the usual triggers: nail biting and picking, long spells of wet work, and injuring the cuticle. Have a nail injury or ingrown toenail looked at early. How well these steps prevent a repeat isn't clear yet.

When to see a podiatrist

See your GP or a podiatrist the same day if:

  • you have a fever, or feel sick or unwell;
  • the redness, swelling or pain is getting worse or spreading, or the pain is moving further up the finger;
  • you can't bend your finger properly;
  • there's pus around the nail, or pus returns after antibiotics or drainage;
  • you have diabetes or poor circulation and any problem around a toenail or on your foot, such as redness, swelling, a wound, a sore, a blister or a colour change.

For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic.

For a child, the same signs matter: a fever or becoming more unwell, more redness and pain, or swelling that's new or getting bigger.

See a podiatrist or your GP if it keeps coming back or has lasted more than 6 weeks. If you have a weakened immune system, see your GP if a nail infection is severe or isn't improving, because foot problems can be more serious.

Common questions

Does a paronychia need to be drained?

Only if a pocket of pus has formed. Mild early cases often settle with warm soaks, but a collection of pus usually needs a clinician to drain it. Try not to lance or squeeze it yourself. A podiatrist or GP can check what's going on first and decide whether draining is the right step.

How is paronychia different from an ingrown toenail?

An ingrown toenail is when the edge of the nail grows into the skin beside it. Paronychia is inflammation of the nail fold, and it can follow an ingrown nail. If you have both, the nail is part of the problem, so a podiatrist can assess and treat the nail as well as the infection.

What is a whitlow, and is it the same thing?

Whitlow is sometimes used as another name for paronychia. A herpetic whitlow, though, is a different problem caused by a virus, and it needs different treatment. A podiatrist or GP can help tell which one you have, so it's worth having a painful nail fold checked.

Further reading

Want to know more? Paronychia (infected nail fold) on Clindice

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod

Podiatrist

Reviewed 27 October 2026. Next review by 27 October 2027.

How we write and review Learn

Was this page helpful?

Related guides

GuideCellulitisCellulitis is a bacterial infection of the skin that makes it red, hot, swollen and painful, most often on a lower leg. Suspected cellulitis needs urgent medical assessment, usually the same day, and often antibiotics. It can come back, so looking after leg swelling and skin matters.GuideBlack toenailA black toenail is usually blood trapped under the nail after a knock, a crush or repeated pressure. Small, painless ones often need only ice, elevation and pain relief, and a clinician can drain a painful one. A dark nail with no clear injury should be checked.GuideNail discolourationNail discolouration is any change in the colour of a fingernail or toenail. Causes range from knocks and nail products to fungal infection and medicines, and most are harmless. Treatment depends on the cause, so it's worth confirming it first. A single new or changing dark band needs a doctor's check.

Sources

(15)
  1. 1.Nail abnormalitiesnidirect · 2017
  2. 2.Acute and chronic paronychiaRigopoulos D, Larios G, Gregoriou S et al. · American Family Physician · 2008
  3. 3.Acute and chronic paronychia of the handShafritz AB, Coppage JM · The Journal of the American Academy of Orthopaedic Surgeons · 2014
  4. 4.Bacterial and viral infections of the nail unit: Tips for diagnosis and managementIorizzo M, Pasch MC · Hand Surgery & Rehabilitation · 2024
  5. 5.Acute and Chronic Paronychia Revisited: A Narrative ReviewRelhan V, Bansal A · Journal of Cutaneous and Aesthetic Surgery · 2022
  6. 6.ParonychiaDuhard É · Presse Medicale · 2014
  7. 7.An infection around your finger or toe nailNHS
  8. 8.Expert Consensus on the Management of Adverse Events from EGFR Tyrosine Kinase Inhibitors in the UKCalifano R, Tariq N, Compton S et al. · Drugs · 2015
  9. 9.Display Patient Information LeafletsUniversity Hospitals Plymouth NHS Trust · 2022
  10. 10.ParonychiaNHS
  11. 11.Nail disordersNHS
  12. 12.Acute and Chronic ParonychiaLeggit JC · American Family Physician · 2017
  13. 13.ParonychiaNHS
  14. 14.Toenail paronychiaLomax A, Thornton J, Singh D · Foot and Ankle Surgery · 2016
  15. 15.Fungal nail infectionNHS · 2017

This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.

Searching…