Candida paronychia

Paronychia or onychomycosis caused by Candida spp. (mostly C. albicans).

• Women : Men 3:1
• especially on the index or middle finger

• Predisposition factors
  • ↑ Exposure to moisture
  • Contact with carbohydrates
  • Hyperhidrosis
  • Acrocyanosis
  • Diabetes mellitus
• Infection with Candida albicans can occur as a result of injuries (e.g. to the cuticle). The pathogens enter the proximal nail wall and infiltrate the entire paronychium

• Buckled, pressure-dolent, reddish inflamed nail wall.
• Erythematous, often pressure-dolent swelling of the paronychium. Associated detachment of the eponychium from the nail plate may lead to bacterial invasion and further mycosis. The nail plate may develop transverse grooves, and in the case of bacterial colonisation (P. aeruginosa), a greenish discolouration may occur.
• Clinically, a distinction from tinea unguium (caused by dermatophytes) is not possible.

• Anamnesis regarding predisposition factors
• Clinical
• Bact. and myco. smear from pus, scales or nail material

• Treatment of the predisposing factors
• No cutting of the cuticle
• Frequent disinfection in soapy water or iodine-povidone solution
• Roughen the nail plate (with nail files)/ream
• Alternatively:
  • Removal of the diseased nail plate (→ ↓fungal volume, ↑active substance penetration)
  • Surgically (by podiologies) or chemically (40% urea paste NRF 5.11-650)

Topical therapy

• Subsequent use of an antifungal nail varnish
• Ciclopirox nail varnish 2x/week for 6-12 mon
• Amorolfin- nail varnish 2x/week for 6-12 mon.

• Best used under a rubber fingerling
  • Clotrimazole cream 1-2 times a day
  • Ciclopirox cream 1-2x tgl.
  • Amorolfin cream (0.25%) 1-2x tgl.

Systhem therapy

• Itraconazole p.o. 400 mg 1x weekly, followed by a break in therapy of 3 weeks. Repeat the cycle 2x (3 cycles in total) or 400 mg 1x daily for 1 week, then 1x weekly (scheme according to Tietz). Always use until healing.
• Alternatively: Fluconazole p.o. 150 mg 1x weekly or 150 mg 1x tgl. for 7 days, then 1x weekly (scheme according to Tietz). Always use until healing.

1. Gupta AK, De Doncker P, Haneke E. Itraconazole pulse therapy for the treatment of Candida onychomycosis. J Eur Acad Dermatol Venereol 2001;15:112-5.
2. Singal A, Khanna D. Onychomycosis: Diagnosis and management. Indian J Dermatol Venereol Leprol 2011;77:659-72.
3. Piraccini BM, Gianni C. Update on the management of onychomycosis. G Ital Dermatol Venereol 2013;148:633-8.
4. Bahunuthula RK, Thappa DM, Kumari R, Singh R, Munisamy M, Parija SC. Evaluation of role of Candida in patients with chronic paronychia. Indian J Dermatol Venereol Leprol 2015;81:485-90.
5. El-Komy MH, Samir N. 1064 Nd:YAG laser for the treatment of chronic paronychia: a pilot study. Lasers Med Sci 2015;30:1623-6.
6. Gianni C. Treatment and prevention of paronychia using a new combination of topicals: report of 30 cases. G Ital Dermatol Venereol 2015;150:357-62.