Dealing with Nail Bed Issues: What to Do After Self-Treatment for Paronychia

I seem to have pulled off my nail bed due to an issue with paronychia?

Hello, doctor.
I have been suffering from paronychia for many years.
During my student years, I underwent nail bed surgery, but it recurred after three years.
After the surgery, I had to wear sandals for two weeks each time.
Now that I have to go to work, I really cannot undergo this surgery again, so I have been trimming my nails myself, and it has been going smoothly each time.
My method is to cut from the upper edge of the nail at the side (the affected area) down to the bottom and then pull out the trimmed piece of nail.
However, just now, as usual, after cutting and pulling it out, I noticed that the base of the pulled nail was connected to a white strip-like substance.
I initially thought it was flesh, but it seems like it isn't.
Moreover, that "flesh strip" is tightly attached to the small piece of nail I cut off.
Did I accidentally pull up the entire nail bed from the edge? Do I need to go to the hospital for further treatment, or can I just use some disinfectant and let it heal naturally?

A Fei, 20~29 year old female. Ask Date: 2013/10/16

Dr. Huang Zhihui reply Surgery

The nail and the epidermal layer of the skin are quite similar in structure, and they can sometimes adhere tightly.
Therefore, when you pull off part of the nail, it is inevitable that some of the epidermal tissue near the nail groove may also be pulled away.
As long as there is no bleeding, it usually does not require treatment, and it will quickly grow back.
If there is a wound, you can apply some povidone-iodine for disinfection.
It is advisable to avoid cutting too deeply next time to prevent incomplete cuts that could lead to paronychia or wound infection.

Reply Date: 2013/10/16

More Info

Dealing with nail bed issues, particularly after self-treatment for paronychia, can be quite concerning, especially when you notice unusual changes in the nail bed or surrounding tissue. Paronychia is an infection of the skin around the nails, often caused by bacteria or fungi, and can lead to symptoms like redness, swelling, and pain. It’s important to approach this situation with caution, especially since you have a history of nail bed issues and previous surgery.

From your description, it sounds like you may have inadvertently removed part of the nail bed along with the nail. The white strip you observed could be the nail matrix or a part of the nail bed that has been exposed due to the removal of the nail. This can lead to complications such as infection, delayed healing, or even permanent changes to the nail growth if not treated properly.

Here are some steps you should consider taking:
1. Clean the Area: Gently clean the affected area with mild soap and water. Avoid using harsh chemicals or alcohol, as these can irritate the skin further.

2. Disinfect: After cleaning, apply an antiseptic solution to the area to prevent infection. Over-the-counter antiseptics like hydrogen peroxide or iodine can be effective. However, be cautious with the amount you use, as excessive application can also irritate the skin.

3. Protect the Area: If the area is open or raw, consider covering it with a sterile bandage to protect it from dirt and further injury. Change the bandage regularly, especially if it becomes wet or dirty.

4. Monitor for Signs of Infection: Keep an eye on the area for any signs of infection, which may include increased redness, swelling, warmth, pus, or worsening pain. If you notice any of these symptoms, it is crucial to seek medical attention promptly.

5. Avoid Further Manipulation: Refrain from cutting or pulling at the nail or surrounding skin until the area has healed. Further manipulation can exacerbate the issue and lead to more complications.

6. Consult a Healthcare Professional: Given your history of nail bed issues and the current situation, it is advisable to consult a healthcare professional. They can assess the extent of the damage and provide appropriate treatment, which may include antibiotics if an infection is present, or other interventions to promote healing.

7. Consider Professional Treatment: If you find that self-treatment is leading to recurrent issues, it may be worth considering a visit to a dermatologist or a podiatrist. They can provide specialized care and may offer treatments that can help prevent future occurrences, such as proper nail trimming techniques or even surgical options if necessary.

In summary, while minor nail bed injuries can sometimes heal on their own, your specific situation warrants caution. Given the potential for complications, it is best to seek professional medical advice to ensure proper healing and to prevent further issues. Taking proactive steps now can help you avoid more serious problems down the line.

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