TAKE-HOME LEARNING POINTS
• Fungal infection is approximately 18 times less likely to occur in fingernails than in toenails, so skepticism is warranted in such cases.
• Atopy probably plays a role in the genesis of chronic paronychia, given the sensitivity of atopic skin to wetting and drying.
• The primary goal of treatment in these cases is to encourage reattachment of the cuticle to the nail plate.
• Oral terbinafine is ineffective against candida and should only be used in cases of proven or strongly suspected fungal infection.
• Chronic candidal paronychia can affect one or more fingernails but is almost never seen in toenails.