Candida nail fold infection is relatively common and is usually seen in people with occupations requiring prolonged immersion of hands or feet in water. Micro-organisms, both Candida species and bacteria, invade the area under the nail fold.

Chronic candidal paronychia versus Tinea unguium

Discriminatory signs

chronic candidal paronychia	Tinea unguium
loss of cuticle - the nail plate surface may develop irregular ridges and deformity	nail dystrophy starts distally
bolstering and erythema of proximal, and sometimes lateral, nail folds	separation of the nail plate from the nail
	nail fold remains intact

Management

• candidal paronychia - in general topical treatment e.g. miconazole - treatment lasting 3-6 months may be required, until a new cuticle has formed
  • Systemic treatment is only indicated in the rare person unresponsive to topical treatment. Ideally, a swab or scrapings should be examined to confirm the diagnosis before commencing systemic treatment. Severe chronic Candida paronychia may occur in immunosuppressed people, when systemic treatment is usually necessary
  • may require antibiotic treatment if secondary infection
• tinea unguium - oral antifungal antifungal

Candida as a cause of onychomycosis is relatively rare with most cases of fungal nail infection due to dermatophyte infection.

Reference:

1. Prodigy Clinical Guidance (2002) - Candida - Skin and Nails