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dermdoc19
dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4124
Experience:  30 years practice in general and cosmetic dermatology
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My cuticle and nail fold is receding on 1 finger.

Resolved Question:

My cuticle and nail fold is receding on 1 finger. The cuticle looks like it deteriorated in just a few days. I cannot tell if it is a fungal or other type of infection. I have attached a picture so we can discuss. The left finger is the symptomatic finger (left ring finger). The finger on the right is my asymptomatic right ring finger that I have included for comparison. What is the cause? And what is the treatment?

Submitted: 4 years ago.
Category: Dermatology
Expert:  dermdoc19 replied 4 years ago.

dermdoc19 :

Hello, this is a paronychia. My impression is that it is of Candidal origin, but I cannot be sure without cultures. It does not impress me as being fungal.

JACUSTOMER-esecw6u6- :

Thanks for your response. I'm looking at pictures of paronychia right now, and I'm not able to find anything that's even remotely close to the image I sent. Do you think you can find me a picture of paronychia somewhere that is close enough to my image to convince me to get a culture done?

dermdoc19 :

I can try but, the problem is most text books show " the text book case" they do not show the early or subtle cases. This may indeed not be a Candida paronychia, it could be staph aureus or pseudomonas. I usually treat this by culturing for bacteria and yeast and then taking a guess as to which one to treat. If I lean toward Candida, I treat with Diflucan and if I lean toward bacteria I treat with Cipro (which will cover Staph Aureus and Pseuodomonas).

I usually squeeze the area under the nail to see if I can get an exudate out. If green or yellow: bacteria. If white: Candida.

This might also be trauma or chemical irritation: Did you injure the area?

I usually rely on derm Atlas but I cannot seem to get into that site. There is a picture similar to yours on DermNet NZ. Maybe a few more days advanced.

JACUSTOMER-esecw6u6- :

Can you send me the URL for the image you found on DermNet NZ? Are you referring to this one?

dermdoc19 :

No, it was a different one.

JACUSTOMER-esecw6u6- :

I cannot take Cipro... fluoroquinolones have caused me extremely painful side effects of tendonitis.

dermdoc19 :

At this point there would be no harm in waiting. Bactrim can be used if you have a problem with Cipro (or Levaquin). However, I would wait for culture results which only take 2-3 days. You might apply simple Cortizone 10 to the base of the nail to see if it might just be an irritation.

JACUSTOMER-esecw6u6- :

What about trying Monistat (otc Miconazole) as well? When I squeeze it, I don't get any puss coming out. I squeezed as hard and sharp as I could from every angle.

dermdoc19 :

It may have only irritated so I would try a weak steroid cream or better Maximum Strength Cortaid ointment. If the area begins to bulge, on the sides then it is Paronychia for sure. You can try Monistat, but I do not rely on them for Candida Paronychia. If it is a paronychia, I lean toward Candida since it is fairly beefy red, and non-tender. If you do use those two creams, separate their usage by two hours to avoid diluting the affect of each.

JACUSTOMER-esecw6u6- :

So you recommend Maximum Strength Cortaid instead of Cortizone 10?

dermdoc19 :

I prefer the ointment of either since there is better penetration, less ingredients to be allergic to, and double the strength. But either Cortizone 10 ointment or Maximum Strength Cortaid ointment are fine as long as they are ointments.

JACUSTOMER-esecw6u6- :

How long should I try Max Strength Cortaid ointment and Monistat before ruling out the effectiveness of either of them and come back for more advice?

dermdoc19 :

About 3-4 days.

JACUSTOMER-esecw6u6- :

What signs should I look for to determine progress or failure?

dermdoc19 :

Redness going away, cuticle returning to normal....better. Swelling, tenderness needs further treatment.

JACUSTOMER-esecw6u6- :

Ok. Sounds good. Thank you doctor for your all your help! :)

dermdoc19 :

You're welcome

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