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Fungal Paronychia. Clinical, Diagnosis and Treatment Aspects

  • Fungal Infections of Skin and Subcutaneous Tissue (A Bonifaz, Section Editor)
  • Published:
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Abstract

Purpose of Review

The purpose of this study is to recognize and expand the knowledge of mycotic paronychia as a variable clinical condition due to various predisposing factors and multiple fungal organisms.

Recent Findings

Candida-associated mycotic paronychia is common but other non-dermatophyte molds, such as Fusarium, are identified as potential agents of paronychia and onychomycosis.

Summary

Mycotic paronychia is characterized by inflammation of the proximal or lateral nail folds caused by certain fungi. Mycological analysis is necessary to identify the causal agent and prescribe an appropriate treatment. Further studies are needed to know the involved microorganisms in the disease and the pathogenicity factors involved in this localized area of the nail apparatus.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Allouni A, Yousif A, Akhtar S. Chronic paronychia in a hairdresser. Occup Med (Lond). 2014;64(6):468–9. doi:10.1093/occmed/kqu075.

    Article  CAS  Google Scholar 

  2. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. 2001;63:1113–6. www.aafp.org/afp/2001/0315/p1113.pdf

    CAS  PubMed  Google Scholar 

  3. Daniel CR III, Lorizzo M, Piraccini BM, Tosti A. Grading simple chronic paronychia and onycholysis. Int J Dermatol. 2006a;45(12):1447–8.

    Article  PubMed  Google Scholar 

  4. Daniel CR 3rd. Paronychia. Dermatol Clin. 1985;3(3):461–4.

    PubMed  Google Scholar 

  5. Daniel CR 3rd, Daniel MP, Daniel CM, et al. Chronic paronychia and onycholysis: a thirteen-year experience. Cutis. 1996;58(6):397–401.

    PubMed  Google Scholar 

  6. Lorizzo M, Piraccini BM, Tosti A. Chronic paronychia: different causes and their treatment. Expert Rev Dermatol. 2006;3(1):375–8.

    Google Scholar 

  7. Kingery LB, Thienes CH. Mycotic paronychia and dermatitis a hitherto undescribed condition apparently peculiar to fruit canners. Arch Derm Syphilol. 1925;11(2):186–202. doi:10.1001/archderm.1925.02370020039004.

    Article  Google Scholar 

  8. Hay RJ, Baran R, Moore MK, Wilkinson JD. Candida onychomycosis—an evaluation of the role of Candida species in nail disease. Br J Dermatol. 1988;118(1):47–58.

    Article  CAS  PubMed  Google Scholar 

  9. Hay RJ, Baran R. Onychomycosis: a proposed revision of the clinical classification. J Am Acad Dermatol. 2011;65:1219–27.

    Article  PubMed  Google Scholar 

  10. Simonetti O, Bernardini ML, Arzeni D, et al. Epidemiology of onychomycosis and paronychia in the area of ANCONA (ITALY) over a period of 5 years. Mycopathologia. 2004;158:271–4.

    Article  CAS  PubMed  Google Scholar 

  11. Nenoff P, Paasch U, Handrick W. Infections of finger and toe nails due to fungi and bacteria. Hautarzt. 2014a;65(4):337–48. doi:10.1007/s00105-013-2704-0.

    Article  CAS  PubMed  Google Scholar 

  12. Rigopoulos D, Larios G, Gregoriu S. Acute and chronic paronychia. Am Fam Physician. 2008;77(3):339–48.

    PubMed  Google Scholar 

  13. Elewsky BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415–29.

    Google Scholar 

  14. Torres-Guerrero E, Arenas R. Onychomycosis: an illustrated guide to diagnosis and treatment. In: Tosti A, Vlahovic TC, Arenas R, editors. Candida onychomycosis. Switzerland: Springer International Publishing; 2017.

    Chapter  Google Scholar 

  15. Ameen M, Lear JT, Madan V, et al. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171:937–58.

    Article  CAS  PubMed  Google Scholar 

  16. Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol. 2002;47(1):73–6.

    Article  PubMed  Google Scholar 

  17. Relhan V, Goel K, Bansal S, Garg VK. Management of chronic paronychia. Indian J Dermatol. 2014;59(1):15–20. doi:10.4103/0019-5154.123482.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lorizzo M. Tips to treat the 5 most common nail disorders brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015;33:175–83. doi:10.1016/j.det.2014.12.001.

    Article  Google Scholar 

  19. Daniel CR III, Lorizzo M, Piraccini BM, Tosti A. Grading simple chronic paronychia and onycholysis. J Dermatol. 2006b;45:1447–8.

    Google Scholar 

  20. Dorko E, Jautová J, Pilipcinec E, Tkáciková L. Occurrence of Candida strains in cases of paronychia. Folia Microbiol (Praha). 2004;49(5):591–5.

    Article  CAS  Google Scholar 

  21. Manzano-Gayosso P, Méndez-Tovar LJ, Arenas R, et al. Levaduras causantes de onicomicosis en cuatro centros dermatológicos mexicanos y su sensibilidad antifúngica a compuestos azólicos. Rev Iberoam Micol. 2011;28(1):32–5.

    Article  PubMed  Google Scholar 

  22. Fich F, Abarzua-Araya A, Perez M, et al. Candida parapsilosisand Candida guillermondii: emerging pathogens in nail candidiasis. Indian J Dermatol. 2014;59(1):24–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Arendrup MC. Candida and candidemia susceptibility and epidemiology. Dan Med J. 2013;60(11):1–32. B4698

    Google Scholar 

  24. Mayer FL, Wilson D, Hube B. Candida albicans pathogenicity mechanisms. Virulence. 2013;4(2):119–28.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sardi J, Scorzoni L, Bernardi T, et al. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol. 2013;62:10–24.

    Article  CAS  PubMed  Google Scholar 

  26. Jayatilake JA, Tilakaratne WM, Panagoda GJ, et al. Candidal onychomycosis: a mini-review. Mycopathologia. 2009;168(4):165–73.

    Article  CAS  PubMed  Google Scholar 

  27. Reyes Delgado K, Staines-Boone AT, Amaya Guerra M, et al. Candidiasis mucocutánea crónica. Dermatol Rev Mex. 2013;57:378–81.

    Google Scholar 

  28. Van de Veerdonk FL, Plantinga TS, Hoischen A, et al. STAT1 mutations in autosomal dominantchronic mucocutaneous candidiasis. N Engl J Med. 2011;365(1):54–61. doi:10.1056/NEJMoa1100102.

    Article  PubMed  Google Scholar 

  29. Cano-Pallares C, Ávila-Fuentes AE, Jesús-Silva MA, et al. Piedra blanca y otras infecciones causadas por Trichosporon spp. Dermatol Rev Mex. 2016;60(6):499–507.

    Google Scholar 

  30. Fermin-Goncalves D, Alemán-Mejias E, Colella MT, et al. Estudio de una serie de casos de Tricosporonosis. Dermatol Venez. 2015;53(2):41–5.

    Google Scholar 

  31. Taj-Aldeen SJ, Al-Ansari N, El Shafei S, et al. Molecular identification and susceptibility of Trichosporon species isolated from clinical specimens in Qatar: isolation of Trichosporon dohaense Taj-Aldeen, Meis & Boekhout sp. nov. J Clin Microbiol. 2009;47(6):1791–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Rizzitelli G, Guanziroli E, Moschin A, et al. Onychomycosis caused by Trichosporon mucoide. Int J Infect Dis. 2016;42:61–3.

    Article  PubMed  Google Scholar 

  33. De Almeida Júnior JN, Hennequin C. Invasive Trichosporon infection: a systematic review on a re-emerging fungal pathogen. Front Microbiol. 2016;7:1629. doi:10.3389/fmicb.2016.01629.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology—an update. Part 1: dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges. 2014b;12(3):188–209.

    PubMed  Google Scholar 

  35. Westerberg DP, Voyack MJ. Onychomycosis: current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762–70.

    PubMed  Google Scholar 

  36. Wu F, Feng J, Sang H. Pseudo-clubbing complicated by dermatophyte onychomycosis. Ann Dermatol. 2014;26(2):271–2. doi:10.5021/ad.2014.26.2.271.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lagace J, Cellier E. A case report of a mixed Chaetomium globosum/Trichophyton mentagrophytes onychomycosis. Medl Mycol Case Rep. 2012;1:76–8.

    Article  Google Scholar 

  38. Tortorano AM, Richardson M, Roilides E, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others. Clin Microbiol Infect. 2014;20(Suppl. 3):27–46.

    Article  CAS  PubMed  Google Scholar 

  39. Muhammed M, Anagnostou T, Desalermos A, et al. Fusarium infection report of 26 cases and review of 97 cases from the literature. Medicine (Baltimore). 2013;92(6):305–16.

    Article  PubMed  PubMed Central  Google Scholar 

  40. • Al-Hatmi AM, Hagen F, Menken SB, et al. Global molecular epidemiology and genetic diversity of Fusarium, a significant emerging group of human opportunists from 1958 to 2015. Emerg Microbes Infect. 2016;5(12):e124. doi:10.1038/emi.2016.126. Molecular analyses of Fusaria have revealed medically important and diversity species.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Motamedi M, Ghasemi Z, Shidfar MR, Hosseinpour L, et al. Growing incidence of non-dermatophyte onychomycosis in Tehran, Iran Jundishapur. J Microbiol. 2016;9(8):e40543. doi:10.5812/jjm.40543.

    Google Scholar 

  42. Gupta M, Sharma NL, Kanga AK, et al. Onychomycosis: clinico-mycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereol Leprol. 2007;73(6):389–92. doi:10.4103/0378-6323.37055.

    Article  PubMed  Google Scholar 

  43. Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol. 2012;66:494–502.

    Article  PubMed  Google Scholar 

  44. Hay RJ, Baran R. Fungal (Onychomycosis) and other infections involving the nail apparatus. In: Baran R, de Berker DAR, Holzberg M, Thomas L, editors. Baran and Dawber’s diseases of the nails and their management. UK: Wiley & Sons; 2012.

    Google Scholar 

  45. Maddy AJ, Abrahams JL, Tosti A. Onychomycoses due to non-dermatophytic molds. In: Tosti A, Vlahovic TC, Arenas R, editors. Onychomycosis: an illustrated guide to diagnosis and treatment. Switzerland: Springer International Publishing; 2017.

    Google Scholar 

  46. Gianni C, Cerri A, Crosti C. “Case report: unusual clinical features of fingernail infection by Fusarium oxysporum Mycoses”.1997; 40: 455–459.

  47. De la Herrán P, López Lozano H, Fierro-Arias L, Ponce Olvera RM, et al. Paroniquia micótica por Fusarium solani: reporte de caso y revisión de la literatura. Dermatología CMQ. 2012;10(2):139–42.

    Google Scholar 

  48. Baran R, Tosti A, Piraccini BM. Uncommon clinical patterns of Fusarium nail infection: report of three cases. Br J Dermatol. 1997;136:424–7.

    Article  CAS  PubMed  Google Scholar 

  49. Ikeda I, Ohno T, Ohno H, et al. Case of Fusarium paronychia successfully treated with occlusive dressing of antifungal cream. J Dermatol. 2014;41(4):340–2. doi:10.1111/1346-8138.12420.

    Article  PubMed  Google Scholar 

  50. Bourgeois GP, Cafardi JA, Sellheyer K, Andea AA. Disseminated Fusarium originating from toenail paronychia in a neutropenic patient. Cutis. 2010;85(4):191–4.

    PubMed  PubMed Central  Google Scholar 

  51. Gianni C, Romano C. Clinical and histological aspects of toenail onychomycosis caused by Aspergillus spp.: 34 cases treated with weekly intermittent terbinafine. Dermatology. 2004a;209(2):104–10.

    Article  CAS  PubMed  Google Scholar 

  52. Chiheb S, El Machbouh L, Marnissi F. Paronychia-like cutaneous leishmaniasis. Dermatol Online J. 2015;21(11).

  53. Arce M, Gutierrez-Mendoza M. Primary and disseminated cutaneous coccidioidomycosis: clinical aspects and diagnosis. Curr Fungal Infect Rep. 2016;10(3):132–9. doi:10.1007/s12281-016-0263-4.

    Article  Google Scholar 

  54. Duhard E. Les paronychies. Presse Med. 2014;43:1216–22.

    Article  PubMed  Google Scholar 

  55. Zaraa I, Kort R, Mokni M, Osman AB. Retronychia: a rare cause of chronic paronychia. Dermatol Online J. 2012;18(6):9.1. http://escholarship.org/uc/item/9qr4059j

    Google Scholar 

  56. Vaccaro M, Barbuzza O, Guarneri F, Guarneri B. Nail and periungual toxicity following capecitabine therapy. Br J Clin Pharmacol. 2008;66(2):325–6. doi:10.1111/j.1365-2125.2008.03174.x.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Calderón L, Tirado-Sánchez A, Lázaro-León JM, et al. Frecuencia de alteraciones ungueales secundarias a la administración de taxanos en pacientes mexicanos. Dermatol Rev Mex. 2015;59:493–503.

    Google Scholar 

  58. Lupu I, Voiculescu VM, Bacalbasa N, Prie BE, et al. Cutaneous adverse reactions specific to epidermal growth factor receptor inhibitors. J Med Life. 2015;8(Special Issue):57–61.

    PubMed  PubMed Central  Google Scholar 

  59. Nenoff P, Krüger C, Schaller J. et al. Mycology—an update part 2: dermatomycoses: clinical picture and diagnostics. JDDG. 2014c;1610–0379/2014/1209. doi: 10.1111/ddg.12420.

  60. Migheli Q, Balmas V, Harak H, et al. Molecular phylogenetic diversity of dermatologic and other human patogenic fusarial Isolates from hospitals in northern and central Italy. J Clin Microbiol. 2010a;48(4):1076–84.

  61. Jain S, Seingal VN. Itraconazole versus terbinafine in the management of onychomycosis: an overview. J Dermato Treat. 2003;14:30–42.

    Article  CAS  Google Scholar 

  62. Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol. 2014;7(7):10–8.

    PubMed  PubMed Central  Google Scholar 

  63. Jinna S, Finch J. Spotlight on tavaborole for the treatment of onychomycosis. Drug Des Devel Ther. 2015;9:6185–90. doi:10.2147/DDDT.S81944.

    PubMed  PubMed Central  Google Scholar 

  64. Hay RJ. Antifungal therapy of yeast infections. J Am Acad Dermatol. 1994;31(3 Pt 2):S6–9.

    Article  CAS  PubMed  Google Scholar 

  65. Gianni C. Treatment and prevention of paronychia using a new combination of topicals: report of 30 cases. G Ital Dermatol Venereol. 2015;150(4):357–62.

    CAS  PubMed  Google Scholar 

  66. Gianni C, Romano C. Clinical and histological aspects of toenail onychomycosis caused by Aspergillus spp.: 34 cases treated with weekly intermittent terbinafine. Dermatology. 2004b;209:104–10. doi:10.1159/000079593.

    Article  CAS  PubMed  Google Scholar 

  67. Kamalam A, Ajithadass K, Sentamilselvi G, Thambiah AS. Paronychia and black discoloration of a thumb nail caused by Curvularia lunata. Mycopathologia. 1992;118(2):83–4.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Calle Tercera 7442-4, Centro, Tijuana, Baja California, Mexico

    Martin Arce

  2. Hospital Angeles Tijuana, Tijuana, Mexico

    Daniela Gutiérrez-Mendoza

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  1. Martin Arce
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  2. Daniela Gutiérrez-Mendoza
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Correspondence to Martin Arce.

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This article is part of the Topical Collection on Fungal Infections of Skin and Subcutaneous Tissue

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Arce, M., Gutiérrez-Mendoza, D. Fungal Paronychia. Clinical, Diagnosis and Treatment Aspects. Curr Fungal Infect Rep 11, 98–103 (2017). https://doi.org/10.1007/s12281-017-0286-5

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