Candida paronychia B37.23

Protracted chronic paronychia mostly caused by Candida albicans.

Preferably occurring in adults. Women are affected three times more often than men. About 3/4 of the cases occur on the index or middle finger. Predisposing are work in a humid environment and work with carbohydrates. Other important predisposing factors are hyperhidrosis, acrocyanosis, immune defects and diabetes mellitus. Injuries to the cuticle, e.g. during excessive nail manicure, can cause the yeasts to get under the proximal nail wall and multiply here.

Chronic, usually moderately painful redness and swelling of the nail fold. The cuticle loses its adhesion to the nail plate, so that foreign bodies can penetrate. It is often completely absent. It is not uncommon for bacterial superinfections to occur. Upon pressure or spontaneously, thick white material consisting of horny components, pus and fungal elements may empty from the nail pocket.

S.a.u. Onychia candidosa, s.a.u. Candidiasis.

If persisting for a longer period of time, growth disturbances with thickening, discoloration, surface rippling of the nail plate may occur as well as onycholysis.

In this constellation, Candida onychomycosis is possible.

• Paronychia and onychodystrophy by dermatophytes: onychomycosis, usually existing for months, secondary infestation of the paronychium; detection of the pathogens
• Bacterial paronychia: usually highly acute, detection of the pathogen
• Acrodermatitis continua suppurativa : eminently chronic pustular dermatitis, usually not limited to the nail wall.

A green-black discoloration of the nail plate, especially in its lateral part, is often an indication of a bacterial concomitant infection by wet germs such as Pseudomonas aeruginosa or Klebsiellen.

In case of mycotic infestation of nail, nail bed and nail wall, surgical removal of the nail is recommended, the infection heals promptly. A treatment attempt with an antimycotic nail varnish (e.g. Loceryl nail varnish; Amorolfin) can be useful. In case of non-complicated paronychia (nail and nail bed are free), careful antifungal local therapy with a broad-spectrum antifungal agent such as Amorolfin nail polish/cream(e.g. Loceryl) or bifonazole (e.g. Mycospor) as a solution, then apply cream or ointment in a thick layer. Apply a bandage, if necessary occlusion for hours with rubber fingerling.

Regular prophylactic hand disinfection (e.g. disinfectant spirit (NRF 11.27.)). No cutting of the cuticle. In case of nail wall injuries, consistent antiseptic local therapy (e.g. with polyvidon iodine ointment R204 ). Hand-warm soap baths, 5-10 min., preferably with curd soap, but also liquid soaps have proved to be effective. The bath water should appear milky turbid.

Itraconazole (e.g. Sempera) has proven to be effective in complicated paronychia (nail mycotic attack), dosage 100 mg/day p.o. until healing or as interval therapy 200 mg twice a day for 7 days, 3 weeks break and repeat the cycle twice more.

Alternatively: Fluconazole (e.g. Diflucan Derm) 50 mg/day p.o. until healing.

1. Crawford F et al (2002) Oral treatments for toenail onychomycosis: a systematic review. Arch Dermatol 138: 811-816
2. Ellis DH (1999) Diagnosis of onychomycosis made simple. J Am Acad Dermatol 40: S3-S8
3. Gupta AK et al (2003) Non-dermatophyte onychomycosis. Dermatol Clin 21: 257-268
4. Gupta AK et al (2000) Itraconazole pulse therapy for the treatment of Candida onychomycosis. J Eur Acad Dermatol Venereol 15: 112-115
5. Hay RJ (1999) The management of superficial candidiasis. J Am Acad Dermatol 40: S35-S42