Diagnosis: Chronic paronychia
Diagnosis: Chronic paronychia Findings: “Nail folds are swollen, erythematous, tender and lifted off the nail plate.” -- Dr Alaa Saad Key teaching points: Often lacks the fluctuance seen in acute paronychia though sometimes small amounts of pus can be present Often exacerbated by water contact Mixed microbes often involved including yeast and bacteria There may [ ]
Diagnosis: Chronic paronychia Findings: “Nail folds are swollen, erythematous, tender and lifted off the nail plate.” -- Dr Alaa Saad Key teaching points: - Often lacks the fluctuance seen in acute paronychia though sometimes small amounts of pus can be present - Often exacerbated by water contact - Mixed microbes often involved including yeast and bacteria - There may be an underlying component of dermatitis - Treatment may include keeping fingers dry, using barrier creams, topical corticosteroids, antibiotics and anti-yeast medication - Trauma should be avoided to the area Credit: Case submitted by Dr. Alaa Saad to dermRounds Dermatology Network
Chronic swelling, erythema, and tenderness of nail folds with loss of cuticle. Occupational wet work. Repeated episodes. Nail dystrophy may develop secondary to chronic nail matrix inflammation.
Avoid wet work, use cotton-lined rubber gloves. Topical corticosteroid (fluconazole or clobetasol) applied to nail fold. Topical calcineurin inhibitor. Antifungals only if Candida confirmed. Cuticle restoration is the goal.
• 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an infection — it is an eczematous/inflammatory condition of the nail fold • Traditional "Candida" explanation is outdated — Candida is a secondary colonizer, not the primary cause • Key pathogenic mechanism: loss of cuticle seal → chronic irritant exposure → inflammation cycle •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: dermatologist, dermrounds