A. Chronic infections around the edge of the nail, paronychias, are caused almost universally to Candida albicans. Moisture predisposes to Candida.

B. Acute perionychia presents as tender, red, swollen areas of the nail fold, but not the nail itself. Pus may be seen through the nail plate or at the paronychial fold. The most common causative bacteria are staphylococci, beta-hemolytic streptococci, and gram-negative enteric bacteria. Predisposing factors to perionychia include minor trauma and splinters under the nail.

C. Diagnosis of paronychial lesions. Chronic lesions are usually caused by Candida and may be diagnosed by KOH prep or by fungal culture. Acute lesions are usually bacterial and may be cultured for bacteria.

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