Chloronychia
To access the content, please log in to the platform.
Image
Licensed by Depositphotos Inc.
- Localization. Nails: hands or feet
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Chronic: more than 2 weeks
- Skin lesion. Flat: macule or spot
- Surface texture. Normal/smooth
- Edges Well defined and regular
- Color. Other colors: orange, yellow, gray
- Distribution of lesions. Discreet/isolated injury: 1 to 5 injuries
- Associated symptoms.
- Additional information.
Brief information
- Chloronychia, or green nail syndrome (GNS), most often translates into a P. aeruginosa infection of the nail.
- The diagnosis of P. aeruginosa infection is more likely if the characteristic triad is observed:greenish color of the nail plate.
- chronic proximal paronychia.
- distal onycholysis.
- Green discoloration can range from blue-green, brownish-green to yellow-green.
- It can involve fingernails or toenails and is generally confined to just one or two nails.
- May have partial or total involvement of the nail plate
- The nail is generally painless; however, the skin around the nail may be erythematous or sensitive.
- Predisposing factors for P. aeruginosa nail infection include:
- immunosuppression
- humid environment due to prolonged exposure to water, soaps and detergents
- occupational infection (community and hospital environment)
- nail pathology (paronychia, onychotillomania, local trauma and nail psoriasis).
- onychomycosis (the presence of fungi favors colonization and can enhance the growth of P. aeruginosa in the nail)
Differential diagnosis
- Subungual hematoma
- Malignant melanoma
- Onychomycosis
- Exogenous pigmentation by chemical substances
Treatment
[!] there are no treatment guidelines. Recommendations are based on some case series studies.
- Removal/cutting and cleaning of the onycholytic portion of the nail and keeping the nails dry throughout the treatment period.
- Topical treatment (application 2 to 4 times a day, for 1 to 4 months)
- Liquid formulations (solutions or lotions) appear to be more effective than creams or ointments. They dry faster and penetrate the onycholytic nail plates better. Options include:
- immersion in 0.25% to 1.0% acetic acid, 10 minutes, twice a day (can be obtained with a 1:4 dilution of white vinegar in water);
- antibiotic or combination of antibiotics:
- silver sulfadiazine
- aminoglycosides (gentamicin, tobramycin)
- quinolones (ciprofloxacin, ofloxacin)
- neomycin/polymyxin B and bacitracin
- Liquid formulations (solutions or lotions) appear to be more effective than creams or ointments. They dry faster and penetrate the onycholytic nail plates better. Options include:
- Systemic treatment (if topical therapy fails):
- ciprofloxacin 500 mg/day for 3 weeks
- Consider concomitant treatment for possible fungal co-infection.