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dermdoc19
dermdoc19, Dermatologist
Category: Dermatology
Satisfied Customers: 4069
Experience:  30 years practice in general and cosmetic dermatology
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I am 48 years old and am struggling with a chronic

Customer Question

Hi, I am 48 years old and am struggling with a chronic paronychia on my the index finger of my dominant hand. The doctor was unable to get an adequate sample for a culture due to a lack of extractable fluid. Initially using Mupirocin ointment, followed by a week of oral Doxycyclin, followed by a week of oral antifungal med seemed to help but not eradicate it. The best results were seen with Clobetasol ointment for the inflammation (was told to apply under a bandaid 2x/day). However, over the past few weeks the redness and tenderness worsened again. The dermatologist put me on 2 20 mg tabs of prednisone a day and now it is getting even worse, not better. Thank you for your time.
Submitted: 2 years ago.
Category: Dermatology
Customer: replied 2 years ago.
Since being diagnosed with the paronychia, I do use gloves to protect my finger when my hands are submerged in water continually .e.g., while doing dishes. I also initially experienced damage to the nail bed (resulting in nail breakage at the base) but this tear in my nail is finally growing out. I am concerned that, now that the condition is worsening again, the nail damage could return. My dermatologist seems to be at a loss for what to do at this point. I am not ready to give up and I don't want to lose my fingernail. Thank you.
Customer: replied 2 years ago.
The problem began in April.
Customer: replied 2 years ago.
fyi, The Clobetasol no longer can keep it from worsening, although using it definitely slows the rate of worsening down. Am currently at the halfway point in the course of oral prednisone I was prescribed and am scheduled to go down to one 20 mg tablet daily for the next week to taper off. The finger is quite sore at this point, and, as I mentioned, has worsened since beginning the course of oral prednisone. Thank you. Let me know if I can provide you with any more information or clarify.
Expert:  Dr. Pravin replied 2 years ago.

Hello

Welcome and Thank you for your query posted.

My name is***** and being a Skin, Hair and Nail specialist I would be able to provide you with an appropriate solution to your concern.

Please note that my Goal is to provide you with an Excellent Service .

Before I answer your question I would like to get some more information:

Could you send me a photo of the condition at your convenience?

You can upload the photo on www.photobucket.com and send me the link

Other method of uploading photo or a file is:

1.Click the paperclip icon

2.Click the Browse icon

3.Click the Browse button

4.Select your file and click Open

5.Click OK

6.Click Insert

7.Click Save Changes on this page

Please note that the answer provided is for information purpose only and does not substitute a Doctor - Patient Consultation in Clinic

Customer: replied 2 years ago.
Hello Dr. Pravin, Here are photos of my left index finger, as you had requested. Since it can be hard to discern from a picture, I wanted to mention that there is no palpable fluid. Also, the tear in the nail (that had originated in the unhealthy nail bed and moved its way up the nail as healthy nail grew in) ripped all the way across last night, which is why the nail is now so short. I don't know if this is important but if you were wondering about my current medications besides the Clobetasol ointment and the prednisone, I also use topical Retin-A cream .025% to manage blemishes on my face. I try to take care to avoid it getting on my inflamed finger when I apply it to my face. Other than that, just supplements. I am orally taking biotin in case that might help. Thank you.
Expert:  Dr. Pravin replied 2 years ago.

Do you have history of Diabetes?

Customer: replied 2 years ago.
No,I do not.
Expert:  Dr. Pravin replied 2 years ago.

This condition is non infective . This is not bacterial or fungal . The nail matrix is involved as it can be seen with the redness and swelling at the base of the nail . the nail looks brittle and has mild pits and striations.

This looks more like psoriasis of the nails . This is the reason it has responded best to Clobetasol .

Oral prednisolone is not a good idea in psoriasis.

An injection of a depot corticosteroid ( triamcinolone ) injection into the inflammed tissue below the nail plate the method of treatment and will give you relief and prevent permanent damage to the nail.

Do you have finger joint pains?

Does anybody in the family have psoriasis?

Do you have lower back pain?

Customer: replied 2 years ago.
Hello, I do not have finger joint pains. No one in my family has psoriasis, to my knowledge. I thankfully do not suffer from lower back pain. Can you tell me more about psoriasis? Is it related to joint or lower back pain? Also, how can you tell that it is not bacterial or fungal? What would cause this condition to occur or recur? Would I need ongoing injections? Thanks!
Expert:  Dr. Pravin replied 2 years ago.

Psoriasis is a chronic inflammatory condition that results collection of body inflammatory cells ( white blood cells ) in the dermal ( deeper skin layers ) . This can also affect the nails like in your case.

psoriasis is associated with lower spine arthritis issues and hence causes the back pain and similarly can cause finger joint arthritis.

As there is not much loss of the cuticle of the nail and skin looks bright red with no color changes as per fungal infections , I can tell you that this is not fungal or bacterial.

This condition is commonly chronic and hence keeps recurring and intra lesional injection as I have mentioned can help in reducing the inflammation.

You may need one or may be 2 injections . Mostly the condition can get resolved once the inflammation subsides

You can also take Biotin vitamins and more of fish oils( omega fatty acids )

Please do get back to me in case of any further queries.

Do you Agree with what I have mentioned?

Would you like me to release the application for giving me a rating for my answer provided?

Expert:  Dr. Pravin replied 2 years ago.

Psoriasis is a chronic inflammatory condition that results collection of body inflammatory cells ( white blood cells ) in the dermal ( deeper skin layers ) . This can also affect the nails like in your case.

psoriasis is associated with lower spine arthritis issues and hence causes the back pain and similarly can cause finger joint arthritis.

As there is not much loss of the cuticle of the nail and skin looks bright red with no color changes as per fungal infections , I can tell you that this is not fungal or bacterial.

This condition is commonly chronic and hence keeps recurring and intra lesional injection as I have mentioned can help in reducing the inflammation.

You may need one or may be 2 injections . Mostly the condition can get resolved once the inflammation subsides

You can also take Biotin vitamins and more of fish oils( omega fatty acids )

Please do get back to me in case of any further queries.

Do you Agree with what I have mentioned?

Would you like me to release the application for giving me a rating for my answer provided?

Customer: replied 2 years ago.
I have been taking fish oil capsules, so I will continue to do that, thanks. Would l continue to use the Clobetasol after the injection(s)? Is there anything else I should be using afterwards to help the area heal? How long might it take for the inflammation to clear up after the injections? Can any dermatologist administer these injections? And are there any side effects? I was also wondering what might have triggered this psoriasis episode, and what I could do preventatively.
Customer: replied 2 years ago.
Thanks!
Customer: replied 2 years ago.
Oh, and why isn't the prednisone helpful with something like this?
Expert:  Dr. Pravin replied 2 years ago.

Clobetasol may not need to be continued after the injection.

Nothing else but the injection would help.

It may take upto a week post injection for the area to heal .

Yes , Dermatologists can inject this area.

There are no side effects apart from mild bruising ( temporary ) from the injections.

Preventive you should take Fish oils , Biotin supplements , moisturise the nail area daily.

Oral prednisolone is not indicated for psoriasis as the inflammation is very much localised in your case.

Regards

Dr Pravin

Do you Agree with what I have mentioned?

Would you like me to release the application for giving me a rating for my answer provided?

Customer: replied 2 years ago.
Thank you, ***** ***** helpful information. Do you know what might have caused this problem? Was it excessive moisture, or is it caused by an overactive autoimmune system? Can I expect the psoriasis to spread or remain localized to the one fingernail bed? About a year ago after having a vacation-triggered sun rash my doctor tested me and told me that I had an elevated ANA test result. Is the elevated ANA in any way connected to this problem?
Expert:  Dr. Pravin replied 2 years ago.

The cause can be autoimmune or genetic . An over reactive immune system ( auto immunity ) is the most common cause.

It can be variable . Mostly in your case since you have it for many months and it has not spread as yet , it would remain confined to the finger nail bed.

The ANA test elevation is itself indicative of any autoimmunity in the body .

It can be a trigger factor in your case. Please do get back to me in case of any further queries.

Do you Agree with what I have mentioned?

Would you like me to release the application for giving me a rating for my answer provided?

Customer: replied 2 years ago.
What steps can I take to stop my immune system from overreacting? Thanks.
Expert:  Dr. Pravin replied 2 years ago.

You would need to have omega fatty acids and treat the local inflammation in the area. Till the area is inflammed , the body would keep reacting