Candidal paronychia (pediatric) - Nail and Distal Digit
Candidal paronychia is a type of inflammation and infection of the nail folds. There is usually a disruption in the barrier between the nail plate and nail fold with subsequent colonization or infection with the yeast Candida albicans. Candidal paronychia is uncommon in children and infants. Risk factors include excessive thumb-sucking or repeated exposure to wetness. It may also be seen in immunocompromised children, including transplant patients or those with human immunodeficiency virus (HIV) infection or chronic mucocutaneous candidiasis. Candidal paronychia can be acute or chronic.
In acute paronychia, there is pain, erythema, and edema of the nail folds. If it progresses, pus may develop. In severe cases, granulation tissue may form and there may be permanent nail dystrophy. The most common causative infective organism in acute paronychia is Staphylococcus aureus (see bacterial paronychia), but C. albicans has been isolated.
In chronic paronychia, there is inflammation of the nail folds that lasts more than 6 weeks. While Candida is often isolated, in most cases, it is colonization rather than a pathogen. It presents with erythema, mild tenderness, and swelling of the nail folds without fluctuance. There is discharge in some cases, and the nail plate may be onycholytic, thickened, and/or yellow. An ingrown nail may be present and contributory. Chronic paronychia is frequently seen in patients with diabetes and immunosuppressed patients as well as those who frequently have their hands in water. Individuals affected by an inflammatory dermatosis such as eczematous dermatitis and other diseases that can cause onycholysis are at an increased risk. There may be staphylococcal or Pseudomonas superinfection.
B37.2 – Candidiasis of skin and nail
187017007 – Candidal paronychia
- Nail fold dermatitis
- Contact dermatitis (irritant, allergic)
- Chronic mucocutaneous candidiasis
- Herpetic whitlow
- Squamous cell carcinoma
- Pustular psoriasis
- Ingrown toenail
- Acropustulosis continua
- In newborns, when multiple nails are involved, consider epidermolysis bullosa simplex, psoriasis, and acrodermatitis.
Last Updated: 06/19/2019