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 of the lateral nail margins. Small amounts of purulent discharge expressible from beneath the proximal nail fold. No fluctuance typical of acute paronychia.
Symptoms developed gradually over 6 months. Patient works as a bartender with frequent wet work and exposure to citrus juices. Prior treatment with multiple courses of oral antibiotics (cephalexin) provided only temporary relief. No history of diabetes. Nail cultures grew Candida albicans and Pseudomonas aeruginosa.
Occupational modification: advised to wear cotton-lined waterproof gloves during wet work and minimize hand washing frequency. Barrier cream (dimethicone-based) applied to nail folds before shifts. Topical ciclopirox 8% lacquer for antifungal coverage. Topical methylprednisolone aceponate for inflammation. Avoidance of manicures and trauma to the cuticle area. If persistent, consider topical tacrolimus for chronic inflammation component.
Tags: nail disease, infection, Candida, occupational, chronic