Treatment for Infected Hangnail
For an infected hangnail, the recommended treatment is daily antiseptic soaks with dilute vinegar or 2% povidone-iodine, followed by application of a topical antibiotic such as bacitracin 1-3 times daily, with warm compresses for pain relief. 1
Initial Assessment and Management
Identifying an Infected Hangnail
- Swollen, erythematous, and painful periungual skin
- Possible gap between nail fold and nail plate
- Potential purulent discharge if bacterial infection is present
First-Line Treatment
Antiseptic Soaks
Topical Antibiotics
- Apply bacitracin to the affected area 1-3 times daily 2
- May be covered with a sterile bandage
- Continue until infection resolves (typically 5-7 days)
Pain Management
- Warm compresses for pain relief
- Avoid manipulation of the affected area
Management Based on Severity
Mild Infection
- Continue with antiseptic soaks and topical antibiotics
- Keep the area clean and dry
- Avoid trauma to the area
Moderate to Severe Infection
- If pus is present, culture the discharge 1
- Consider mid to high potency topical steroid ointment to nail folds twice daily for inflammation 1
- If bacterial infection is confirmed, treat according to culture results
Advanced or Refractory Cases
- If not responding to topical treatment within 48-72 hours, consider oral antibiotics
- For recurrent, severe, or treatment-refractory cases, doxycycline 100 mg twice daily may be considered 1
- Consult with a dermatologist if infection extends beyond the nail fold or if there are signs of systemic infection
Prevention of Recurrence
- Keep nails trimmed and smooth
- Avoid biting or picking at hangnails
- Moisturize cuticles regularly
- Wear protective gloves when hands are exposed to water for prolonged periods
- For torn hangnails that haven't yet become infected, surgical glue can be used to paste them back in their original position 3
Special Considerations
Candida Infection
If Candida is suspected (more common in people who frequently immerse hands in water):
- Antifungal treatment may be necessary
- Amorolfine 5% nail lacquer applied once or twice weekly may be effective 1, 4
Underlying Conditions
- Diabetes or immunosuppression may require more aggressive treatment and closer monitoring
- Consider systemic therapy earlier if infection is not responding to topical treatment
Common Pitfalls to Avoid
- Neglecting proper hand hygiene, which can worsen infection
- Cutting the infected tissue aggressively, which may spread infection
- Stopping treatment prematurely before complete resolution
- Failing to address occupational factors (frequent water exposure) that may contribute to recurrence
- Misdiagnosing fungal paronychia as bacterial infection, leading to inappropriate treatment
Remember that while most infected hangnails respond well to conservative treatment, persistent or worsening symptoms warrant prompt medical attention to prevent complications such as spreading cellulitis or permanent nail damage.