Nails infection in children

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Question: Hi doctors. I have an 8 mths baby girl who is having an infections to her all 10 finger nails. Those infected nails will finally end-up with smelly pus under the nails. My questions are i) what type of infection & what is the best medicine? Is it okay to feed her with oral medicine? ii) how long it will take to cure? iii) is it normal it occur amongst babies & it is hv long term effect? Pls help. Tq. (Asked by Syima Saiyuti)

Dear Syima,

Thanks for the question. First of all, the question that u asked was specifically directing at nails infections. In saying so, I’m assuming the diagnosis is correct.

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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.

Paronychia can develop as a result of these:

  • Nails 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 (ie frequently playing with water/swimming or activities that involve a job of washing dishes in restaurant for an adult)

Paronychia usually happens when the skin around a person’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 in the skin 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 waterclogged 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 bacterial, 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 about a week.

Treatment

  1. Antiseptic soaks – If the cause is bacteria, soak the infected finger 3 times a day for 10-15 minutes in warm water and liquid antibacterial solution. Do this until the wound has dried up and healing.
  2. Antibiotic ointments (for bacterial infection) – Antibiotic ointment can be applied over the area 2-3 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 occasionally needed.
  3. 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 with rubbing alcohol. Make an opening where the pus pockets joins with the nail. If the pus doesn’t 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.
  4. Yeast (Candida) infections – Topical antifungal cream can be applied for 2-3 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 (eg. paracetamol, ibuprofen), itchiness, if present (antihistamine). 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 you.
Prevention

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Do not 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.

I would advise you to consult a paediatrician if your child’s nails infections persist. Paediatric dermatologist advise may be needed.

I hope I have answered your questions.

Regards,
Dr. Aileen

 

References:

  1. http://www.childrenshealthnetwork.org/CRS/CRS/pa_nailinfe_hhg.htm
  2. http://www.aboutkidshealth.ca/EN/HEALTHAZ/CONDITIONSANDDISEASES/SKINHAIRANDNAILDISORDERS/Pages/Fingernail-Infection-Paronychia.aspx
  3. http://kidshealth.org/parent/infections/skin/paronychia.html

(written by Dr. Aileen)


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2 responses to “Nails infection in children”

  1. Dr Aileen Avatar
    Dr Aileen

    *comment notification*

  2. Spongebob squarepants Avatar
    Spongebob squarepants

    Hi aileen…kihkih saja gatecrash this website…