Clinico-onychoscopic correlation of chronic paronychia – A single-center observational cross-sectional study

Objectives: The aim of the study is to study the association between the clinical and onychoscopic findings seen in chronic paronychia as well as establish its association with the severity of the disease, if any. Onychoscopy is a non-invasive, cost-effective, and rapid hands-on technique for better understanding of nail pathologies, allowing photographic documentation and monitoring of disease progression and response to treatment. Nail disorders often present with subtle macroscopic changes making diagnosis difficult, and thus the minute changes visible on onychoscopy aid very much in clearing the diagnostic dilemma in most cases. Chronic paronychia, being a common disease affecting the nail unit, has not been explored much through onychoscopy. Materials and Methods: A total of 40 patients with clinical evidence of chronic paronychia were included in the study. After a thorough clinical examination, both wet and dry onychoscopic evaluation of the affected nails was done. Results: Most common clinical findings were swelling and scaling of the proximal nail fold (90%), followed by proximal nail fold erythema (87.5%), destruction and scaling of the lateral nail fold (75%), yellowish-brown discoloration of the nail plate (62.5%), beau’s line (17.5%), and onychomadesis (12.5%). Effacement of the cuticles (82.5%) and red dots on the nail bed (82.5%) were the most common onychoscopic findings. The onychoscopic findings of effacement of the cuticles (69.7%) were commonly seen in secondary candidial colonization and linear regular brown striations (61.5%) in dermatophyte invasion of the nail plates. Conclusion: In a busy outpatient department, the onychoscopic examination can be an instant outpatient setting tool to identify the underlying fungal infections associated with chronic paronychia.