Background: Chronic paronychia is a very recalcitrant dermatosis. The involvement of Candida in the pathogenesis of chronic paronychia (CP) has never been proven, even though this condition is commonly considered a type of Candida onychomycosis.
Objectives: were to define the possible etiological factors in pathogenesis of CP and to compare the efficacy of different therapeutic modalities.
Methods: 100 female patients with CP were enrolled.
They were subdivided into 5 groups (20 patients each) .Mycological, open patch test with fresh foods and standard (TRUE) patch test were done for each patient. Biopsies were taken from the proximal nail fold (PNF) before open patch testing and from patients with positive test reaction. Each group was treated as follows G1 (oral Itraconazole 200 mg/day), G2 (oral Ciprofloxacin 1gm/day), G3 (topical Fluticasone propionate0.05% cream), G4 (Itraconazole 200 mg/day, Ciprofloxacin 1gm/day and Fluticasone propionate cream) and lastly G5 (the control group) with placebo. The treatment duration was 3 weeks and the follow up visit was after 6 weeks.
Results: Candida was isolated by KOH 20% and culture SDA+C medium in 50% of our patients before treatment and C. albicans was isolated in 46 (92%) of them .Positive reactions to open patch testing with fresh foods were reported in 33% of our patients. Standard patch test showed positive reactions to allergens in 15 (15%) patients. G4 showed highly significant clinical response to treatment when compared with other groups as the total number of improved/ cured patients was 14 patients at the end of treatment and 19 patients at the follow-up visit.
Conclusion: The results of the present study support the opinion that contact irritants play a primary role in pathogenesis of CP in patients with predisposing factors that cause cuticle damage and Candida plays a secondary role.
Combination therapy with systemic antifungal, systemic antibiotic and topical steroid gave the most significant clinical response in patients with CP.
|
