Chronic paronychia and Allergy

Chronic paronychia and Allergy

Widodo Judarwanto

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia.

It has a complex pathogenesis and is caused by multifactorial damage to the cuticle, thereby exposing the nail fold and the nail groove. Previously, it was believed that chronic paronychia is caused by Candida. However, recent data reveals that it is a form of hand dermatitis caused by environmental exposure. Candida is often isolated; however, in many cases, Candida disappears when the physiologic barrier is restored. Hence, the recent view holds that chronic paronychia is not a mycotic disease but an eczematous condition with a multifactorial etiology. For this reason, topical and systemic steroids may be used successfully, whereas systemic anti-fungals are of little value. Some study discovered that topical steroids are more effective than systemic anti-fungals in the treatment of chronic paronychia. Although Candida was frequently isolated from the PNF of their patients with chronic paronychia, Candida eradication was not associated with clinical cure in most patients. In a study conducted by Rigopoulos D et al., tacrolimus 1% ointment and betamethasone 17-valerate cream was found to be more effective in patients of chronic paronychia than just emollient application, confirming allergens and irritants have indeed  important contribution to the pathogenesis of chronic paronychia.

Chronic paronychia commonly afflicts house and office cleaners, laundry workers, food handlers, cooks, dishwashers, bartenders, chefs, nurses, swimmers, diabetes, and patients on HIV-ART. Hypersensitivity to foodstuff is responsible for an increased incidence in food handlers

Chronic paronychia is a condition that is pathologically characterized by spongiotic inflammation; it can be exacerbated by various and concomitant factors. The immediate hypersensitivity reaction to foods can be responsible for some cases of chronic paronychia in food handlers.

References

  • Vineet Relhan, Khushbu Goel, Shikha Bansal, Vijay Kumar Garg. Management of Chronic Paronychia. Indian J Dermatol. 2014 Jan-Feb; 59(1): 15–20.
  • Tosti A, Guerra L, Morelli R, Bardazzi F, Fanti PA. Role of foods in the pathogenesis of chronic paronychia. J Am Acad Dermatol. 1992;27:706–9.
  • Barlow AJ, Chattaway FW, Holgate MC, Aldersley T. Chronic paronychia. Br J Dermatol. 1970;82:448–53. 
  • Rockwell GP. Acute and chronic paronychia. Am Fam Physician. 2001;63:1113–6
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