What should you know about herpetic paronychia?

The infection can cause grouped clear or cloudy blisters, burning, throbbing pain, redness, and swelling beside the nail. The fingertip may feel unusually tender before blisters appear. It can follow contact with an active cold sore or genital herpes lesion, including contact through broken skin. A bacterial infection more often produces a pocket of pus, so squeezing or opening a blister can worsen irritation and spread the virus to another site.

Because the appearance can overlap with other nail-fold problems, a clinician may examine the finger and decide whether a swab or other test is useful. A skin yeast infection is a different condition and may need different treatment.

Keep the area clean and covered with a light dressing, wash your hands after touching it, and avoid biting nails or picking the skin. Do not pierce, drain, or squeeze the blisters. Avoid sharing towels, nail tools, or gloves, and avoid touching your eyes after contact with the finger. A clinician may discuss antiviral treatment, especially when symptoms started recently or pain is significant. Antibiotics do not treat a herpes virus, although a separate bacterial infection may require antibiotics for skin infection. Abscess drainage is not routine for a blistering viral infection.

Arrange prompt medical review for a painful blistering nail-fold rash, particularly if you have a weakened immune system or the lesion is near the eye. Seek urgent care for eye pain, light sensitivity, vision change, rapidly spreading redness, fever, severe swelling, numbness, or difficulty moving the finger. Contact a clinician if symptoms are not settling, recur, or become covered with pus, because another infection may be present.

Could this be herpetic paronychia rather than a bacterial infection? Would testing change treatment? Should I use an antiviral, and how should I protect other people from contact? What changes would mean I need urgent review?