Hangnail Infection: Signs, Symptoms, and Causes

A hangnail infection is a type of skin infection (paronychia) that happens when a hangnail—flaps of pulled or damaged skin at the base of the nail—becomes infected. This infection occurs when certain bacteria, viruses, or fungi enter the skin tissue of a hangnail.

Common signs of a hangnail infection are pain and swelling around the fingernail or toenail. Wearing artificial nails or having diabetes may raise your chances of developing the condition.

Hangnail infections are common and typically acute (temporary) but can be chronic (long-term) depending on the cause and severity. Treatments can vary, with medications and medical procedures used for complex and advanced cases. There are several ways to treat an infected hangnail and manage its symptoms.

A hangnail infection can be classified as either acute or chronic.

Acute Hangnail Infection

Acute (short-term) hangnail infections are the most common, and bacteria usually cause them. Bacterial hangnail infections usually develop quickly and only affect one finger or toe at a time. Symptoms include pain, swelling, redness, pus, and skin that’s hot to the touch. The symptoms typically go away within a few days, but the infection can take up to six weeks to heal fully.

Nail biting, artificial nails, or injury usually cause acute hangnail infections. Children are particularly prone to acute nail infections due to sucking their fingers and biting their nails.

Chronic Hangnail Infection

Chronic (long-term) hangnail infections lasting over six weeks tend to occur from viruses and fungi. Chemical irritation of the skin, known as irritant dermatitis, can also lead to a chronic hangnail infection.

A chronic hangnail infection usually affects more than one finger or toe at a time, takes longer to develop symptoms, and lasts longer. Symptoms of a chronic hangnail infection may include boggy (spongy or mushy) tissue around the nail, thicker nails, or nail discoloration.

Candida, a kind of yeast, sometimes causes chronic hangnail infections. Candida lives naturally on the skin and will only cause infection if it grows out of control.

You may be more likely to develop a chronic hangnail infection if you:

• Work in jobs where hands are exposed to chemicals or submerged in water for long periods, including as dishwashers, bartenders, laundry workers, housekeepers, florists, and bakers
• Take certain medications, especially those that suppress immune function
• Have conditions that affect immunity, including human immunodeficiency virus (HIV/AIDS), cancer, or diabetes

How quickly hangnail infection symptoms develop depends on the cause. Bacterial infections progress faster, usually within hours or days, while fungal infections have a slower onset. It is possible to have both a bacterial and fungal hangnail infection simultaneously.

The symptoms can be broadly broken down into those affecting the finger around the nail, the nail itself, and the rest of the body.

Symptoms Around the Nail

The main symptoms of a hangnail infection affect the nail fold—the area where the nail meets the skin at the sides (lateral nail folds) and the base (proximal nail fold). Typical signs include:

• Pain, swelling, and tenderness in the affected area
• Skin that’s red and hot to the touch (erythema)
• An abscess, which is a buildup of pus (creamy, white, or yellow fluid) under the skin

Nail Symptoms

In more severe cases, a hangnail infection can change the appearance of the toe or fingernail, including:

• Beau lines, which are deep grooves or ridges in the nail
• Discoloration of the nail, causing it to turn yellow or green
• Dry and brittle nails
• Separation of the nail from the nail bed, which can cause the nail to fall off

Symptoms Throughout the Body

Rarely, hangnail infections spread to other parts of the body. These are known as systemic symptoms. You may experience:

• Fever and chills
• Red streaks on the skin
• Fatigue and a general feeling of unwellness
• Joint pain and swelling
• Muscular pain

A hangnail infection occurs when bacteria, fungi, or other pathogens enter through the skin’s tissues surrounding the nail in the fingers or toes. This happens when the pathogens cross through the breaks or ruptures in the barrier between the nail and nail fold, or cuticle, caused by the hangnail.

Staphylococcus aureus, a skin bacteria, is the most common cause of acute hangnail infections. Other bacteria, like Streptococcus (found in the nose and throat) and Pseudomonas (found in soil and dirt), are usually present in chronic cases. Infection with yeasts, certain fungi, and herpes simplex virus (HSV) can also cause hangnail infections.

Risk Factors

Certain health factors, conditions, and habits raise your risk of developing hangnail infections. These include:

• Hitting your fingernail or toenail, resulting in trauma
• Biting your nails
• Getting manicures and pedicures that are done too aggressively
• Wearing artificial nails
• Sucking fingers or thumbs
• Having ingrown fingernails
• Living with chronic illnesses that impact immunity, such as HIV/AIDS or diabetes
• Working where your skin is exposed to chemicals, such as housecleaning or dishwashing
• Swimming often in chemically-treated water

When diagnosing hangnail infections, healthcare providers work to rule out other potential causes of symptoms. Conditions that can present similarly to a hangnail infection include eczema, psoriasis, herpes, and dermatomyositis (an autoimmune skin disorder).

Along with an evaluation of your medical history, healthcare providers rely on several assessments in diagnosis:

• Physical assessments: Healthcare providers can primarily diagnose hangnail infection by evaluating affected areas and looking for characteristic features of infection.
• Imaging: The healthcare provider may use ultrasound imaging in rare cases to screen for an abscess (pocket of fluid) or deeper infection.
• Clinical testing: If there’s fluid or pus, the provider may collect a sample and send it to the lab to screen for specific yeasts, fungi, or bacteria.

Most hangnail infections resolve on their own with home management techniques for discomfort. More severe cases call for antibiotics or medical treatments.

Home Management

Treating a hangnail or hangnail infection at home should be the first step before seeking additional care. Healthcare providers recommend the following techniques to manage any discomfort and promote healing:

• Warm water soaks: Soaking the affected fingers in warm water and antibacterial soap helps promote blood flow and drain any pus. Do this for 10-15 minutes at a time for up to four times daily.
• Hangnail trimming: After soaking an affected finger, use a cuticle clipper—a tool designed to cut off excess skin—to trim the hangnail. Make sure to disinfect the clipper in alcohol before use.
• Topical treatments: Healthcare providers may recommend over-the-counter (OTC) steroid creams to manage swelling. Antifungal agents are recommended if fungi are causing symptoms. Avoid drugstore triple antibiotic ointments containing neomycin, like Neosporin, due to possible allergic reactions.

Prescription Medications

You should seek medical help if your symptoms persist or worsen despite home management techniques.

Healthcare providers may prescribe topical antibiotics (applied to the skin), like Bactroban (mupirocin) or Cipro (ciprofloxacin). In rare and severe cases, they may prescribe oral antibiotics (taken by mouth), such as Dycill (dicloxacillin), to fight off the infection and prevent it from spreading.

If the infection is fungal, prescription antifungal medications may help.

Medical Procedures

Healthcare providers may need to drain the fluid if there’s an abscess. After cleaning and numbing the affected area, they use a scalpel to create a small cut, allowing the pus to escape. They then disinfect and bandage the area.

You should follow up with your healthcare provider within 24-48 hours to ensure the abscess drains properly and the infection does not worsen.

There’s a lot you can do to prevent hangnails and associated infections, including:

• Keep your hands clean, washing them with gentle soaps to avoid damaging skin
• Avoid biting your nails or ripping off or picking at any hangnails
• Moisturize your fingers, especially if you have dry skin
• Wear latex or protective gloves with a cotton lining to keep hands dry when washing dishes, cleaning, or working with chemicals
• Bring your own tools to manicure or nail salon appointments, and don’t let the manicurist trim your cuticles during your appointment
• Trim your fingernails once a week and use an emery board (a type of nail file) to ensure the edges of your nails are slightly rounded
• Trim your toenails once a month, keeping the edges straight
• Avoid trimming the cuticles or using cuticle removers

If a hangnail infection is severe and goes untreated, the condition can lead to more serious complications, including:

• Hand infection: Severe hangnail infections can spread to surrounding tissues and tendons in the hand. Treatment may require surgery to remove damaged tissue or even amputation.
• Sepsis: This is a severe bacterial infection that spreads to the blood. It is a rare complication that often arises in those with compromised immune systems.
• Nail dystrophy (onychodystrophy): This is a chronic hangnail infection that damages fingernails or toenails. It can lead to brittle, irregular nails if left untreated.
• Green nail syndrome (chromonychia): This is an infection with a certain type of bacteria that can spread to cause fingers or toenails to develop a green color. Surrounding tissues sometimes swell or become sore. 

A hangnail infection happens when bacteria or fungi spread to tissues in the finger or toe next to the nail. Tenderness, pain, discoloration, and swelling of the affected area are common signs.

Hangnail infections tend to resolve on their own when managed at home. At-home treatments include soaking affected fingers or toes in warm water and trimming the hangnail. Medications and medical procedures are reserved for more severe cases.

Keep your nails clean, trim them regularly, moisturize the skin, and wear protective gloves to help prevent a hangnail infection.