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My Child has a Nail Infection

A fingernail infection is an infection at the base of the fingernail caused by bacteria or yeast. In medical terminology, it is known as ‘paronychia’.

The infected area can become swollen, red and painful and a pus filled blister (known as abscess) may form. This infection can occasionally spread to the rest of the fingers or toes. It affects the finger nails much more commonly.

Below are some of the factors that results in paronychia.

  • Nail biting
  • Ingrown nails
  • Frequent sucking of the finger(s)
  • Clipping a nail too short or trimming the cuticle
  • Getting manicures (which include pushing the cuticle down or trimming the cuticle)
  • Having hands in water a lot (i.e. frequently swimming/activities that involve water)

Paronychia usually happens when the skin around your child’s nail is irritated or injured. When the skin in damaged, germs can enter and subsequently cause the infection. These germs can be bacterial (commonly caused by Staphylococcus bacteria) or fungi (commonly caused by yeast, Candida).

If the cuticle has a large pimple or is draining pus, it is usually infected with bacteria. The bacteria usually enter the skin through a break caused by pulling on or chewing on the cuticle.

If the cuticle area is only red and swollen without pus, it is usually due to fungal infection. Yeast infection is commonly seen in children who suck their thumb or fingers, bite their nails, swim a lot or have water clogged cuticles from other activities.

Fungal paronychia usually develops gradually compared with bacterial paronychia, which usually appears very suddenly. Fungal infection may cause less obvious symptoms than a bacterial one, but it can be chronic, meaning it can last for a longer time.

Acute paronychia: The proximal nail fold is red, swollen, and painful and may contain pus. Usually one nail is affected.

Chronic paronychia: The proximal nail fold is swollen, red, has no cuticle (the strip of hardened skin at the base and sides of a fingernail or toenail).

Chronic paronychia can cause changes in the affected nail. It might turn a different colour or look as though it is detached or abnormally shaped. In rare cases, if paronychia is severe and left untreated, the infection can spread past the area of the nail.

Most of the time, the doctor should be able to diagnose paronychia by taking a look at the infected nails. Occasionally, the doctor may take some pus sample and have it examined in a laboratory to determine the type of bacterial and fungus that is causing the infection. With proper treatment, this infection should clear up in about a week.

Treatment

Antiseptic soaks: If the cause is bacteria, soak the infected finger three times a day for 10-15 minutes in warm water and liquid antibacterial solution. Do this until the wound has dried up and healed.

Antibiotic ointments (for bacterial infection): Antibiotic ointment can be applied over the area two or three times a day. Generally, the wound should be left exposed. However in young children who have the tendency of putting the fingers in the mouth, it is advisable to cover the fingers with a bandage. Continue the application until no signs of infection remain. Occasionally, an oral antibiotic is needed.

Open any small pimple: Visible pus pocket needs to be opened and drained. If it’s a small pimple, you can do it with a sterilized needle and rubbing alcohol. Make an opening where the pus pocket joins with the nail. If the pus does not run out, gently squeeze the pus pocket.

If the pus pocket is large and spreading, your doctor may need to drain it. However if you have no sterile needle or you are not confident in performing it, just leave it to your doctor.

Yeast (Candida) infections: Topical antifungal cream can be applied two or three times a day until the area dries up. It is not advisable to cover it with a bandage.

Note: Oral medication is rarely needed unless it is very extensive and is associated with fever. In this case, it is will either be oral antibiotics or antifungal. Other oral medication that may be prescribed by your doctor may include symptomatic relief such as medication to relieve pain and fever (e.g. paracetamol, ibuprofen).

Most of these medications are fairly safe. However, every medication has potential adverse effects. Do enquire from your doctor regarding the benefits and potential side effects of the medications when they are prescribed to your little one.

Prevention

Do not allow your child to pick or chew hangnails (loose pieces of cuticle). Instead, cut these off with nail clippers.

Outcome:

If it is promptly managed and treated, it should not leave any long term effects; unless it is persistent and goes on to develop chronic paronychia.

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