Last Updated: 2019-08-27

Author(s): Anzengruber F., Navarini A.

ICD11: -

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

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

  • Predisposition factors
    • ↑ Moisture load
    • Contact to carbohydrates
    • Hyperhidrosis
    • Acrocyanosis
    • Diabetes mellitus
  • Injuries (e.g. the cuticle) can lead to infection with Candida albicans. The Pathogens enter the proximal nail wall and infiltrate the entire paronychium.

  • Pre-curled, pressure-curled, reddish-irritated nail wall.
  • Erythematic, often pressure-dolent swelling of the paronychium. The associated delamination of the eponychium with the nail plate can lead to the penetration of bacteria and other mycoses. The nail plate can develop transverse grooves, with bacterial colonization (P. aeruginosa) it can come to a greenish discoloration.
  • Clinically a differentiation to tinea unguium (caused by dermatophytes) is not possible.

Bacterial and myco-smear from pus, scales or nail material.

  • Treatment of predisposition factors.
  • No cutting of the cuticle.
  • Frequent disinfection in soapy water or Betadine® Lsg.


Roughen nail plate (with nail files)/milling

  • Alternatively:
  • Removal of the diseased nail plate (→ ↓ ↓ Mushroom volume, ↑ Active substance penetration)
  • Surgical (by podiatrist) or chemical (40% urea paste NRF 5.11-650)


Topical Therapy

  • Subsequent use of an antifungal nail polish
  • Ciclopirox Nail Polish (Ciclocutan®) 2x/week for 6-12 Mon.
  • Amorolfine Nail Polish (Loceryl®) 2x/week for 6-12 months

  • Best used under a rubber finger ring.
  • Clotrimazole cream (Canesten® cream) 1-2x daily
  • Ciclopirox cream (Ciclocutan® Cream or similar) 1-2x daily
  • Amorolfine cream (Loceryl® 0.25% cream) 1-2x daily


Systhem therapy

  • Itraconazole (e.g. Sporanox®) 400 mg p.o. once a week, followed by a therapy break of 3 weeks. Wdh. of cycle 2x (total 3 cycles) or 400 mg 1x per day for 1 week, then 1x per week (diagram according to Tietz). Always use until healed.
  • Alternatively: Fluconazole (e.g. Diflucan®) p.o. 150 mg 1x weekly or 150 mg 1x daily for 7 days, then 1x weekly (Scheme according to Tietz). Always use until healed.

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  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.