A clinicomicrobiological study of chronic paronychia

Accumulating evidence suggests that chronic paronychia is an eczematous condition with multifactorial aetiology and questions the role of Candida as a pathogen. The objectives were to assess the clinical pattern, predisposing factors, and microbial status of chronic paronychia and to compare the efficacy of topical steroids, antiseptics, and antifungals as treatment.

Clinical pattern was assessed and swabs were taken from the gap between the nail fold and cuticle of the most severely affected and normal fingers for microbial studies. The sample was randomly divided into two groups. One group was treated according to the culture with Povidone iodine ointment for bacteria, and with Miconazole tincture for Candida. The other group was given topical 01% Betamethasone Valerate ointment irrespective of the culture.  Patients were reassessed after six weeks.

Of 75 patients the male-female ratio was 1:2 and 38% were housewives. Single hand was affected in 56.66%, which was the dominant hand in 84%. Water and soap were the commonest predisposing factor (64.4%). The commonest association was eczema (29%). Coliforms were predominantly isolated (83.6%) and Candida was isolated in 51%. Steroids indicated a statistically significant improvement compared to the culture specific treatment (p <0.001). For Candida positive cases treatment with steroids showed better outcome than antifungals but this difference was not statistically significant (p>0.05).

Our results favour that chronic paronychia is an inflammatory disorder caused by environmental hazards. Topical steroids are an effective treatment option irrespective of the microbial status.