How to Spot an Infected Nail Bed: Signs, Symptoms, and Treatment (With Pictures)

Infection of the skin around the nail (called paronychia) is one of the most common medical conditions of the hand. This usually happens when the cuticle (a thin fold of skin around the nail) gets disrupted, allowing germs to get in and cause an infection. The cuticle normally keeps germs (bacteria, viruses, and fungi) from invading the underlying tissues. But trauma to the skin fold can cause infection. It can happen spontaneously, too.

Recognizing the signs of infection can help differentiate it from other nail conditions, like squamous cell cancer or psoriasis. Having the right diagnosis is important so you can get proper treatment for your nail bed condition. Let’s take a closer look at what an infected nail bed looks like.

What does an infected nail bed look like?

Infected nail beds can look different depending on what’s causing the infection and how long the infection has been developing. Early in an infection, changes may be barely noticeable or very mild. As the infection develops, changes may be more dramatic and present more symptoms. Some of the most common symptoms of a nail bed infection include:

• Swelling around the nail

• Red or violet discoloration at the nail fold, which can extend down the finger or toe

• Pain and tenderness

• Pus- or fluid-filled blisters

• Loss of cuticle 

• Discoloration of the nail (white, yellowish, or brown)

• Nail ridging or detachment

Nail bed infection pictures

Here are some pictures to help you identify signs of a nail bed infection. 

Paronychia can cause dark redness in the nail fold.

Chronic paronychia causes redness around the nail and also nail ridging.

Bacterial paronychia can cause pus to collect around the nail.

A herpes infection (herpetic whitlow) can also cause infection on the nail bed.

How can you tell if a nail bed infection is bacterial, fungal or viral?

Your healthcare professional can usually diagnose the cause of your nail infection based on your medical history and a physical exam. Some helpful factors to consider include:

• History of the inflammation: Bacterial and viral nail bed infections usually come on suddenly and get worse quickly. Fungal infections develop slowly and can last for weeks to months.

• Physical exam: Bacterial and viral paronychia are usually red and painful. They may have pus bumps. They usually only involve one finger or toe. Fungal nail bed infections are usually not very painful and often involve more than one finger or toe.

• Risk factors: Nail biting and picking at hangnails are more likely to result in a bacterial infection. Regular wet work (like dishwashing) is more likely to lead to fungal infections. 

• Skin culture: A lab can check a sample of the nail or blister fluid for germs. This is useful if the infection gets worse despite treatment, or if it doesn’t improve as expected.

How do you get rid of an infected nail bed?

Treating paronychia depends on what’s causing the infection and how severe the symptoms are. Your dermatologist might recommend treatments like:

• Warm soaks with soap and water 3 to 4 times a day.

• Antibiotics, like amoxicillin-clavulanic acid (Augmentin), clindamycin (Cleocin), or Cephalexin (Keflex) 

• Antifungal medications, like terbinafine and itraconazole

• Topical steroids, like triamcinolone

• Surgical treatment (such as abscess drainage)

Will a nail bed infection go away on its own?

Sometimes a nail infection may go away on its own — especially if it’s a minor bacterial or fungal infection. You should seek medical care for paronychia treatment if you have:

• Severe pain, redness, or swelling

• Drainage or bleeding from the area of infection

• Fever

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Nail bed infections can be more serious in some people. It’s less likely that a paronychia will go away on its own if you have any of these conditions:

• Diabetes

• Overweight or obesity

• HIV

• Peripheral vascular disease

What else can cause nail bed changes besides paronychia?

Not all changes in nail beds are caused by infection. Other medical conditions can cause nail changes, too. Some medical conditions that might cause nail bed changes include:

• Psoriasis

• Cancer

• Thyroid conditions

• Heart conditions

• Lung disease

• Vascular disease

Why trust our experts?

Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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