In this column, I’d like to explain short-lived mild to serious infections around the nail. This information will help you understand the importance of your own hygiene as well as increase your appreciation of the complexity of the nail area and make you aware of when a patient needs medical care.

A quick review of nail anatomy

A quick review of nail anatomy

Acute or short-term infections

Acute, or short-term, infections around the nail can vary in seriousness from mild to severe. An acute infection can be anything from an infected hangnail to an abscess under the nail bed.

A non-infected hangnail

A non-infected hangnail

Although an infected hangnail may seem minor, the amount of movement required form fingers makes me very cautious about infections around the nail.

Although the nail can withstand significant infections without causing permanent deformity, I always warn patients that any permanent deformity is the risk when there’s an infection near the nail bed or matrix.

Minor infections

Minor infections, such as a small pus-filled pocket, an infected splinter, or a hangnail, can usually be treated by the patient with an over-the-counter antibiotic. An excellent self-treatment for an early, mild infection is to apply wet or dry heat for 15 minutes four times a day as well as a topical antibiotic. The heat draws white blood cells to the site to help fight the infection. Wet heat is especially beneficial when the pustule is close to the skin’s surface because the wetness softens the overlying skin to allow drainage. If you can see foreign material, such as a splinter, in the infected area, remove it. Low-grade infections with some pus but little spreading redness usually respond well to removing the foreign matter and treating the area with heat and an over-the-counter topical antibiotic.

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More serious infections demand quick medical attention. Each time the finger is bent, more pressure is put on the infected site, and the infection can spread into surrounding tissues. I have seen a red area on the posterior nail fold advance to a red streak leading up the arm (indicating blood poisoning) in just four hours.

If a patient has redness around several cuticles or fingers, the condition may have been caused by irritation or injury. A single tender area that seems to be spreading is more suspicious as an infection. If you suspect an infection, don’t do any procedures that require touching the soft tissues around the nail. Discontinue the client’s nail service until she has seen a doctor or until the area is completely healed. Many times the infection will clear without a doctor’s attention, but don’t work on an infected area without making sure the client is at least taking antibiotics.

If a splinter or other foreign object is under the nail, don’t try to remove it yourself. I anesthetize the whole finger before trying to remove foreign objects from under the nail.

Sometimes a patient will come to me complaining of great pain around or under the nail just one or two days after seeing another doctor. This indicates there is a pocket of pus under the nail, which can hurt as much as, or worse than, a pocket of blood under the nail. If a client complains of pain even after seeing a doctor, recommend she call the doctor again or go for a follow-up visit.

To find a pus pocket under the nail, I shine a light through the fingernail in a dark room and can sometimes locate the pus pocket. At other times an area under the nail is white because pressure on the blood vessels is cutting off the blood supply. To treat this condition, I anesthetize the finger and make a hole through the nail or through the immediately adjacent area to relieve the pressure.

Rare Infections

A rarer infection around the finger is found in the deeper tissue under the fingertip. Called a felon, it most commonly occurs as the result of a penetrating injury like a puncture wound. As the tissue swells, pressure increases and cuts off the blood supply to the fingertip, worsening the infection. This is a true medical emergency that requires an opening for drainage and internal antibiotics. Infections directly around the nail rarely spread into the deep tissues unless there was a penetrating injury.


Repeated low-grade infections

If a client has repeated low-grade infections around the nail, she is probably tearing at hangnails or picking and biting the nail area. Remind clients to trim hangnails with cuticle scissors and to lubricate the area with an over-the-counter antibiotic ointment. To prevent hangnails, recommend clients regularly use cuticle oil or cream, skin lotion, or other lubricants around the cuticles.

No matter how mild, infections should always be treated with care in the salon. Never work on a client who has an infection near the nail, but refer her to a doctor for treatment.

To avoid causing or spreading infection, always use disinfected or disposable implements on each client. If it’s not practical or cost-efficient to use disposable items, such as files, on each client, reuse them only on the same client and store them in a plastic bag between appointments.

If you nick a client with an instrument or even irritate the cuticles by vigorous filing, apply an over-the-counter antibiotic cream on the area and tell the client what you are doing and why. Minimize her concern by reminding her that you disinfect your instruments and your work surface, use disposable implements when needed, and wash your hands between clients.

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