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Evaluation of role of Candida in patients with chronic paronychia
Rakesh Kumar Bahunuthula, Devinder Mohan Thappa1, Rashmi Kumari
1Department of Dermatology and STD, JIPMER, Puducherry, India.
Background:
Chronic paronychia, earlier considered to be an infection due to Candida, is currently being considered as a dermatitis of the nail fold. Irritant, allergic and protein contact dermatitis are the suggested major pathogenic mechanisms. Hypersensitivity to Candida is more likely to be the etiology, rather than the infection itself.
Aims:
To assess the clinico-etiological profiles of patients with chronic paronychia and to determine the role of contact sensitization and hypersensitivity to Candida.
Methods:
All consecutive patients of chronic paronychia attending the dermatology outpatient department (OPD) were assessed for risk factors, number of nails affected, clinical presentation and presence of fungus, patch tested for contact allergy and prick tested for hypersensitivity to Candida allergen.
Results:
A total of 80 patients of chronic paronychia were recruited into our study. There was female preponderance (66 patients, 82.5%), with the most common group affected being housewives (47 patients, 58.8%). Frequent washing of hands (64 patients, 80%) was the most common risk factor. Fungal culture was positive in 56.1% (41 patients), the predominant species cultured was Candida albicans (15 patients, 36.5%). Patch testing with Indian standard series was positive in 27.1% patients (19 out of 70 patients tested), with nickel being the most common allergen. Prick test with Candida allergen was positive in 47.6% patients (31 out of 65 patients tested).
Limitations:
Prick test and patch test provide indirect evidence of hypersensitivity, with inherent limitations.
Conclusion:
Our study shows that chronic paronychia is probably a form of hand dermatitis associated with prolonged wet work, and that there is a higher incidence of contact sensitization and Candida hypersensitivity in these patients.
Insights
Chronic paronychia is likely a form of hand dermatitis linked to wet work, showing increased contact sensitization and Candida hypersensitivity. These findings highlight the importance of identifying allergens and immune responses in affected individuals.
Area of Science:
- Dermatology
- Immunology
- Mycology
Background:
- Chronic paronychia, once thought to be a Candida infection, is now viewed as nail fold dermatitis.
- Key pathogenic mechanisms include irritant, allergic, and protein contact dermatitis.
- Hypersensitivity to Candida, rather than direct infection, is a more probable cause.
Purpose of the Study:
- To evaluate the clinical and etiological profiles of patients diagnosed with chronic paronychia.
- To investigate the roles of contact sensitization and Candida hypersensitivity in the condition.
Main Methods:
- Eighty patients with chronic paronychia were assessed for risk factors, affected nails, and clinical presentation.
- Fungal presence was evaluated, alongside patch testing for contact allergies and prick testing for Candida hypersensitivity.
- Patients were recruited from dermatology outpatient departments.
Main Results:
- Female patients and housewives were predominantly affected.
- Frequent hand washing was the most common risk factor identified.
- Positive fungal cultures were observed in 56.1%, with Candida albicans being most common.
- Patch testing revealed nickel as a frequent allergen, and Candida hypersensitivity was noted in 47.6% of patients.
Conclusions:
- Chronic paronychia is likely a hand dermatitis associated with prolonged wet work.
- A higher incidence of contact sensitization and Candida hypersensitivity is observed in patients with chronic paronychia.
- Prick and patch tests offer indirect evidence of hypersensitivity, though limitations exist.
