chronic skin disease

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Chronic paronychia skin disease

 When candida invades the skin around the base of the nails, it causes a glazed, red, bolster-like swelling, with loss of the cuticle. To begin with the condition may cause some pain and this may be intermittent thereafter, but on the whole the inflammation is indolent and chronic, lasting for months or years. An occasional bead of pus may exude from under the nail folds. secondary deformities of the nail-plates occur, such as ridging and fur-rowing, due to damage of the nail matrix. Not infrequently, however, the organism also invades the nail-plate, causing a dark brown pigmentation at its lateral margins, which slowly extends both medially and peripherally. Very occasionally the nail-plate is involved in the absence of a preceding paronychia. Chronic paronychia is an occupational disease of housewives, roughly 90% of all cases occurring in this group. It is also seen in certain industries, such as fruit-canning, in which the hands are continually wet. This wetness causes maceration and destruction of the cuticle and the organism then gains admission via oral  contamination. The majority of cases begin on the middle finger of the right hand and secondary infection with gut organisms is not, uncommon. Other factors which contribute to infection are trauma and chronic perniosis.

 Treatment

 The pathogenesis of the condition should be explained to the patient. Every effort must be made to keep the affected fingers dry by wearing fabric-lined plastic gloves, although they must be thoroughly though gently washed. after defaecation. Perniosis must be treated if present. Nystatin ointment is applied with a chisel-pointed orange stick under the nail fold four times a day and again at night. It may also be rubbed into the nail-plate when this is involved. In spite of the most careful treatment, however, recovery rarely takes place in under two or three months and may take much longer. Occasionally, some other fungicide proves effective when nystatin fails, the two best being amphotericin B lotion (Fungizone) and Onychophytex, a proprietary paint. Oral nystatin alone is ineffective since it is not absorbed from the gut, but it can be helpful in preventing re-infection.