If Not Fungal Infection, Then What?

TAKE-HOME LEARNING POINTS

• Fungal infection is approximately 18 times less likely to occur in fingernails than in toenails, so skepticism is warranted in such cases.

• Atopy probably plays a role in the genesis of chronic paronychia, given the sensitivity of atopic skin to wetting and drying.

• The primary goal of treatment in these cases is to encourage reattachment of the cuticle to the nail plate. 

• Oral terbinafine is ineffective against candida and should only be used in cases of proven or strongly suspected fungal infection.

• Chronic candidal paronychia can affect one or more fingernails but is almost never seen in toenails.