Tuesday, July 21

Chronic paronychia - Fungal (candidal) paronychia

  ›     ›     ›   Chronic fungal and candidal paronychia
What is chronic paronychia?
Chronic paronychia is the persistent or long-lasting inflammatory reaction involving the folds of tissue surrounding a fingernail or toenail.
It is usually caused by the reaction of the proximal nail fold to irritants and allergens and subsequent fungal, more often candidal infection. Candidal paronychia may last for more than six weeks.

Causes of chronic paronychia

Chronic paronychia is prevalent in persons whose hands or feet are frequently exposed to moist conditions. Warm and moist conditions are ideal for contracting fungal infections. Candidal nail fold infection is caused by the fungus species Candida albicans. This multifactorial inflammatory reaction of the nail fold and candidal fungal infection can be as the result some of the causative factors such as,

Signs, symptoms and diagnosis

The nail fold affected by candidal or fungal infection may present with symptoms like reddening (erythema), tenderness and edema (swelling). The cuticle may appear retracted and separated from the nail plate. The proximal nail fold may appear retracted and the adjacent cuticle may be absent. Usually more than one finger is involved and frequently thumb and second or third fingers of the dominant hand are affected by candidal fungal infection. The nail plate gets discolored, thickened and disfigured. Transverse ridges appear due to inflammation and damage to the nail matrix caused by chronic fungal or candidal infection.

The physical examination of the affected nail folds and correlating the symptoms with the history of the presence of causative factors helps in the diagnosis of the nail fold disease. The candidal fungal paronychia may have to be differentiated from other conditions affecting the fingertips, such as squamous cell carcinoma, malignant tumors, eczema and psoriasis.
picture of thumb affected by chronic paronychia and Fungal (candidal) paronychia
Chronic paronychia - Fungal (candidal) paronychia
(Picture author: Rob Hille | CC BY-SA 3.0)

Prevalence and prevention

Chronic fungal nail fold infection and inflammation is prevalent in laundry workers, agricultural laborers, food handlers, drain cleaners, cooks, dishwashers, bartenders, fishermen, fishmongers, fish farm workers, dairy workers, confectioners, nurses, watersports personals and swimmers. Following certain preventive measures can protect a person from developing fungal or candidal infection of the nail fold. Use of gloves, gumboots and avoiding nail fold trauma and irritation can prevent chronic candidal paronychia.

Fungal paronychia treatment

Chronic candidal paronychia is treated by avoiding exposure to the causative factors. In case of milder infection, broad-spectrum topical antifungal cream and a steroid cream is applied. If the infection is severe, oral antifungals and steroids are also prescribed. Recalcitrant candidal or fungal paronychia may be treated by excision of the proximal nail fold or eponychial marsupialization. The resolution of chronic, fungal or candidal paronychia may take several weeks or months and there is the risk of recurrence.
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References:
1.Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008 Feb 1;77(3):339-46.
2.Shafritz AB, Coppage JM. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. 2014 Mar;22(3):165-74.
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Current topic in natural skin care: Chronic, fungal, candidal paronychia
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