Diagnosis: Chronic Paronychia
A 45-year-old female bartender presenting with swollen, erythematous, tender nail folds on multiple fingers with loss of cuticle and nail plate changes.
Nail folds are swollen, erythematous, tender and lifted off the nail plate on the 2nd, 3rd, and 4th fingers of both hands. Loss of the cuticle with retraction of the proximal nail fold. Nail plates show irregular, ridged surface with greenish discoloration.
Symptoms developed gradually over 6 months. Patient works as a bartender with frequent wet work. Prior treatment with multiple courses of oral antibiotics provided only temporary relief. Nail cultures grew Candida albicans and Pseudomonas aeruginosa.
Occupational modification: cotton-lined waterproof gloves during wet work. Barrier cream applied to nail folds before shifts. Topical ciclopirox 8% lacquer for antifungal coverage. Topical methylprednisolone aceponate for inflammation. Avoidance of manicures.
• Acute paronychia (bacterial) • Herpetic whitlow • Psoriatic nail disease • Onychomycosis • Squamous cell carcinoma of nail fold • Melanoma (amelanotic, subungual) • Eczematous dermatitis
• Chronic paronychia is NOT primarily an infection — it is an eczematous/inflammatory condition of the nail fold • Traditional "Candida" explanation is outdated — Candida is a secondary colonizer, not the primary cause • Key pathogenic mechanism: loss of cuticle seal → chronic irritant exposure → inflammation cycle • Most common in "wet workers": bartenders, cleaners, housekeepers, healthcare workers, food handlers • Cuticle loss is the critical finding • Treatment focuses on barrier restoration, NOT antifungals alone • Topical steroids + barrier protection (avoidance of wet work) is more effective than antifungals
Tags: nail disease, infection, Candida, occupational, chronic