Medical Oncologist
Skin side effects
Nail infections during chemotherapy
The skin around the nail turns red, swollen, warm and painful, often throbbing, sometimes with pus. It usually starts at a torn cuticle, an ingrown corner or a lifting nail. During the low-count days of a cycle it is a possible source of serious infection, so it needs your team the same day, and fever with it is an emergency.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
How do you recognise a nail infection during chemotherapy?
The skin around the nail becomes red, swollen, warm and painful, often throbbing, and there may be pus at the edge of the nail or under it. It commonly starts at a torn cuticle, a hangnail, an ingrown corner, or under a nail that has started to lift. Outside treatment it is a nuisance. During the low-count days of a cycle it is a possible source of a serious infection, and it needs your team the same day.
This is not the same as the harmless ridges, dark bands and brittleness that many drugs cause. Those change the nail itself. An infection changes the skin around it: the redness, the swelling, the heat and the pain are what give it away.
Report it the same day
Early antibiotics or simple treatment are far easier than managing an infection that has spread. Do not wait for the next appointment or for it to come to a head.
Take your temperature
An infected nail with any fever at or above your team's threshold is an emergency, because it may mean the infection has entered the bloodstream.
Do not squeeze, cut or lance it
Opening it at home pushes bacteria deeper and creates a wound. Keep it clean, dry and covered until it has been seen.
Never apply turmeric, hot oil or shop antibiotic cream and wait. Get it seen.The signs
What an infected nail looks and feels like
- Redness at the nail fold
- The skin along the side or base of the nail turns red, or darker and shiny on brown skin. It often starts at one corner.
- Swelling and warmth
- The area puffs up and feels hot compared with the other fingers or toes. Rings or footwear may start to feel tight.
- Throbbing pain
- Pain that pulses, worsens when the hand hangs down, or keeps you awake is typical of infection rather than simple soreness.
- Pus
- Yellow or white fluid at the edge of the nail, under it, or in a small blister beside it. A clear sign of infection.
- Spreading redness or red streaks
- Redness extending along the finger or toe, or red lines running up the hand, foot or limb, means the infection is spreading. This is urgent.
- Feeling unwell
- Fever, shivering, or suddenly feeling very unwell with an infected nail needs the emergency department immediately.
Not sure whether this applies to you?
Ask an oncologistPractical
Preventing nail infections during treatment
Most start with a small break in the skin. Prevent the break.
Leave the cuticles alone
Do not cut, push back or bite cuticles, and do not tear hangnails. Trim a hangnail cleanly with sterilised scissors if it catches.
Avoid during treatment
- Salon manicures and pedicures
- Shared nail clippers and files
Trim nails straight across
Short, straight-cut nails with clean clippers kept for the patient only. Cutting into the corners of toenails causes ingrown nails, a common starting point for infection.
Keep hands dry
Long soaking in water softens the nail folds and lets bacteria and fungus in. Use cotton-lined gloves for washing vessels and clothes, and dry hands thoroughly.
Also
- Moisturise the nail folds each evening
- Cover any small cut with a clean dressing
Look after the feet
Roomy footwear, clean cotton socks changed daily, feet dried between the toes, and a daily check for redness, especially with diabetes or numbness.
Protect a lifting nail
A nail separating from its bed traps moisture and dirt. Trim the loose edge, keep it dry and covered, and check it daily.
!
Go to the nearest emergency department immediately for any of these
An infected nail with a temperature at or above your team's threshold · shivering uncontrollably or feeling suddenly very unwell · red streaks spreading up the finger, hand, toe, foot or limb · rapidly spreading redness or swelling · severe pain with the finger or toe turning pale, dusky or numb. Say clearly that the person is on chemotherapy. For redness, swelling or pus around a nail without these signs, contact your team the same day rather than waiting.
Being straight with you
What this page cannot tell you
It cannot tell you what treatment an infected nail needs. That might be soaks and dressings, antibiotic tablets, a small procedure to drain it, or, with low counts, admission for antibiotics through a drip. The decision depends on how severe it is and where you are in the cycle, and it needs somebody to examine it.
It also cannot tell you whether it is bacterial or fungal. The treatments differ, and applying the wrong cream can make things worse. That is one more reason to have it seen rather than treated from the pharmacy shelf.
Low counts change the stakes
The same infection that would settle on its own at other times can spread quickly when white cells are low. Ask your team which days of your cycle are riskiest, and treat nail problems on those days as urgent.
Some drugs make it more likely
Certain targeted treatments cause painful inflamed nail folds that can become infected. If you are on one, your team may suggest particular care from the start.
Diabetes and numbness hide it
People with diabetes or numb feet may not feel an infected toenail until it is advanced. A daily look at the feet is the only reliable way to catch it early.
Home remedies delay the right treatment
Turmeric paste, hot oil, garlic and antiseptic soaks are often tried first, and the delay allows spread. Clean, dry and covered is the safe interim step while you contact the team.
What to do next
Look for redness, swelling, heat, throbbing or pus around any nail. If you find them, keep it clean, dry and covered, take your temperature, and contact your team the same day. Go to emergency for fever or spreading red streaks. Prevent further problems by leaving cuticles alone and keeping hands dry.
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Commonly believed
Four ideas that delay treatment
"It is only a small swelling; it will burst and heal."
During low counts a small nail infection can spread quickly. Report redness, swelling or pus the same day rather than waiting for it to come to a head.
"Turmeric paste will draw the infection out."
Home remedies delay proper treatment and can irritate the skin. Keep it clean, dry and covered, and have it seen.
"I can open it with a clean needle."
Lancing at home pushes bacteria deeper and creates a wound. If it needs draining, that is done safely by the team.
"An antibiotic cream from the pharmacy is enough."
Some nail infections need tablets or are fungal rather than bacterial. During treatment, the team should decide what is needed.
Questions we are asked
Common questions about nail infections
How do I know if my nail is infected?
Redness, swelling, warmth and throbbing pain in the skin around the nail, often with pus at the edge or under it. Nail ridges or dark bands alone are not infection; the changes in the surrounding skin are what matter.
Is a nail infection serious during chemotherapy?
It can be, especially during the low-count days, because infection spreads more easily. Contact your team the same day, and go to emergency for fever or red streaks spreading from the area.
What should I do while waiting to be seen?
Keep it clean, dry and lightly covered, take your temperature, and avoid squeezing, cutting or applying home remedies. Rest the hand or foot and keep it raised if it throbs.
Will I need antibiotics?
Often, but it depends on severity, your counts, and whether the infection is bacterial or fungal. Some need draining. Your team will decide after examining it.
Can I soak it in warm salt water?
Ask your team first. Warm soaks help some mild infections, but long soaking softens the skin and is not a substitute for being seen during treatment.
How can I prevent it happening again?
Leave cuticles alone, trim nails straight across, wear gloves for wet work, keep feet dry in roomy footwear, and check hands and feet daily, especially during the low-count days.
Can I still have my next cycle?
That depends on how the infection responds and on your blood counts. Tell your team about it before treatment day so they can decide whether to go ahead or wait.
I have diabetes. Should I be more careful?
Yes. Diabetes slows healing and can hide early pain, particularly in the feet. Check your feet daily and report any redness or swelling around a toenail promptly.
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Sources
- Macmillan Cancer Support — Chemotherapy and infection risk
- American Cancer Society — Skin Problems
- National Cancer Institute — Chemotherapy and You: Support for People With Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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