Nail Candidiasis

Abstract

Onychomycosis caused by Candida is often accompanied by paronychia. Not only the morbid changes in the nailplate caused by the true parasitism by Candida but also the secondary changes in the nail due to candidial paronychia are sometimes handled as though they were candidial onychia. Onychomycosis caused by candidial infection, i.e., nail candidiasis, is entirely different in its pathogenetic respects from the secondary ungual changes due to candidial paronychia. The reason why both are classified together as candidial onychia appears attributable to the ambiguous characterization of their clinical and pathological features. We therefore undertook a statistical analysis of 765 cases of candidiasis who visited the Dermatological Department of Tokyo University Hospital during the period from 1969 to 1980. Of these, 25 cases of nail candidiasis (primary onychia) were sorted out, followed by clinical and pathological examinations. The results showed that nail candidiasis appeared in 14.3% of the candidial paronychia and onychia cases, and no significant differences from candidial paronychia were attributable to age or sex. On the other hand, it was found that nail candidiasis was clinically characterized by subungual hyperkeratosis, while the fungal element appeared histopathologically in the lower part of the nailplate, taking an abnormal parasitic form similar to that in dermatophytes. The pathogen causing nail candidiasis was Candida albicans and was resistant to various therapies. The only effective therapy was oral administration of Ketoconazole. Nail candidiasis is often accompanied by underlying diseases like SLE which result in cellular immunodeficiency. While chronic mucocutaneous candidiasis occurs with a background of congenital cellular immunodeficiency to Candida, nail candidiasis appears to have an acquired immunodeficiency as the background. In short, nail candidiasis can be interpreted as a candidiasis which occurs when the host/parasite relations are disturbed. In this sense, it appears that nail candidiasis can be regarded as a dermadrome which reflects cellular immunodeficiency of host.

Epidemiological and mycological data of onychomycosis in Goiania, Brazil

“…12 The reason for the higher frequency of fungal infection of fingernails among women is probably because of the frequent immersion of the hands in water (associated with working in wet environment as housewives) or exposure to chemicals and trauma. 8,13 Although previous reports have indicated that dermatophytes are responsible for most of the nail infections, 3 we found that onychomycosis caused by yeast was the most common clinical form with C. albicans isolated in 71.4% of cases. This species has been frequently found in onychia and paronychia by yeast.…”

“…The increased prevalence of onychomycosis in the toenails in men could be the result of more traumas in the nails because of occlusive footwear, which favours the appearance of disease 12 . The reason for the higher frequency of fungal infection of fingernails among women is probably because of the frequent immersion of the hands in water (associated with working in wet environment as housewives) or exposure to chemicals and trauma 8,13 …”

Yeasts of the genus Candida are the dominant cause of onychomycosis in Libyan women but not men: results of a 2-year surveillance study

“…However, others have reported no notable difference, 8 while some investigators found fungal infection of fingernails to be more common in men than women 10 . The reason for the greater frequency of fungal infection of fingernails among women is probably due to the frequent immersion of the hands in water or exposure to chemicals and trauma 11 . In addition, women are more concerned about the appearance of their fingernails than men.…”

Case Report and Review. Onychomycosis due to Candida parapsilosis Fallbericht und Ubersicht. Onychomykose bedingt durch Candida parapsilosis

“…The traumatic aetiology of the dystrophy must be pointed out. The role of dystrophy of the nail in relation with systemic disease such as systemic lupus erythematous has been previously stressed [11] as well as the role of diabetes mellitus and chronic administration of corticosteroids. Cushing's syndrome and Raynaud's disease were also considered as risk factors [2].…”

“…The aetiological responsibility of C. parapsilosis in mixed infections is questionable, as in a study including 39 healthy subjects, C. parapsilosis was isolated in 51.3% of the cases [11], indicating that this fungus was one of the main species of the microflora of the subungual space. It is very likely that in most cases, C. parapsilosis colonizes the surface of nails invaded by another Candida species responsible for the clinical event.…”