title: Evaluation of role of Candida in patients with chronic paronychia.
abstract: 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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Prick test and patch test provide indirect evidence of hypersensitivity, with inherent limitations.
  
  
  CONCLUSIONS
  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.
authors.forename: Rakesh Kumar
authors.initials: RK
authors.lastname: Bahunuthula
authors.affiliation: Department of Dermatology and STD, JIPMER, Puducherry, India.
authors.forename: Devinder Mohan
authors.initials: DM
authors.lastname: Thappa
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kumari
authors.forename: Rakesh
authors.initials: R
authors.lastname: Singh
authors.forename: Malathi
authors.initials: M
authors.lastname: Munisamy
authors.forename: Subash Chandra
authors.initials: SC
authors.lastname: Parija
mesh_terms: D000328:Adult; D002175:Candida / Q000276:immunology / Q000302:isolation & purification*; D002908:Chronic Disease; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000276:immunology / Q000473:pathology; D010304:Paronychia / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D010328:Patch Tests / Q000379:methods