Mycopathologia 118: 83-84, 1992. 9 1992 Kluwer Academic Publishers. Printedin the Netherlands.
Paronychia and black discoloration of a thumb nail caused by Curvularia lunata A. Kamalam, K. Ajithadass, G. Sentamilselvi & A.S. Thambiah
Mycology Section, Department of Dermatology, Madras Medical College and Government General Hospital, Madras 600 003, India Received 18 April 1991; accepted in revisedform 29 August 1991
Key words: Black nail, clotrimazole, Curvularia lunata, paronychia
Abstract
Chronic paronychia associated with black discoloration of the left thumb nail in a 51 year old female caused by Curvularia lunata is reported for the first time. The keratolytic activity of the fungus in the nail and its complete clearance by topical clotrimazole are reported.
Introduction
Paronychia is an acute or chronic inflammatory disorder of the nail folds. The nail changes associated with paronychia are secondary to the inflammation of the nail folds, particularly the proximal fold under which the nail matrix is placed. The etiologic factors involved may be primary or secondary. The primary causes are often traumatic such as simple injury or 'hang nail' or maceration following thumb sucking or frequent soaking in water, soaps, detergents, alcohol, vinegar, fruit juices, salt and sugar solutions and hence occupational. Sometimes a spirochetal, Treponema pallidum, infection may present as primary paronychia [1]. The secondary causes are by such bacteria as Staphylococcus aureus, S. albus, Streptococci group A, Escherichia coIi, Pseudomonas aeruginosa and Proteus vulgaris, and fungi such as Candida albicans. It should be emphasised that there is always a primary predisposing cause for these symptomatic secondary infections. Successful treatment is achieved when
these factors are considered along with the infections. Bacterial and fungal infections either singly or in combinations produce inflammation and swelling of the nail folds and deformity of the affected nail in the form of transverse grooves (Beau's lines). The swollen nail folds become separated from the nail plate and produce pockets which allow collection of water and other contactants including bacteria and fungi. This process results in painful discharges from such a site. The present report is of a patient with chronic paronychia and black discoloration of the nail caused by Curvularia lunata. Such an infection caused by this dematiaceous fungus has not been reported previously.
Case report
A 51 year old housewife was seen with a mild painful paronychia and black discoloration of the
84 twice daily for 2 months by which time the black color disappeared and the inflammation subsided.
Discussion
Fig. 1. Paronychia with black discoloration of the left thumb nail due to Curvularia lunata.
nail of her left thumb (Fig. 1) of 3 months duration. No treatment had been instituted previously for this condition. Scraping from the black area of the nail surface and the region beneath the cuticle showed brown septate conidia in 10% KOH mount and grew grey brown to olivaceous black colonies in profusion with aerial mycelium on Sabouraud's dextrose agar within 4 days. Culture mounts in lactophenol cotton blue showed brown, septate, branched mycelium and smooth, thick-walled, multiseptate conidia. These conidia showed 3 septa with a larger sub-apical cell and a typically curved outline characteristic of C. lunata. The nail scrapings in slide culture on corn meal agar also showed similar brown conidia germinating from the nail cells to produce hyphae, conidiophores and the typical conidia of C. lunata. The patient was advised to keep away from water, detergents and household work as much as possible and to use rubber gloves over cotton gloves while handling water, detergents etc. Topical 1% clotrimazole liquid was applied
Although brown and green discolorations of nails due to bacteria and C. albicans have been observed in association with paronychia, black color was not met with in our previous cases of onychomycosis. The present case is the first of its kind. This is also the first time C. lunata has been isolated from black nails. This agent has been isolated from the soil and plants of South India [2] and is a rare agent of mycetoma [3] and mycotic keratitis [4]. The brown septate conidia and hyphae observed in the nail scrapings of the present case have been frequently encountered in some skin lesions resembling tinea and eczema in our patients. Routine culture in future nail cases would give interesting and useful information as to how many of them are caused by C. lunata, since the keratolytic action of Curvularia species has been reported by some investigators [5]. The beneficial effect of clotrimazole is encouraging in paronychia and associated onychomycosis with black nails.
References 1. Stokes JH, Garner VC. The landmarks of late syphilis on skin and mucous membrane. In: Stokes JH, ed. Modern Clinical Syphilology. Philadelphia: WB Saunders, 1934: 771-870. 2. Subramaniam CV. Systematic account. In: Hyphomycetes. New Delhi: Indian Council of Agricultural Research, 1977: 783 -785. 3. Rippon JW. Mycetoma. In: Medical Mycology, 3rd ed. Philadelphia: WB Saunders, 1988: 80-118. 4. Emmons CW, Binford CH, Utz JP, Kwong-Chung KJ. Mycotic Keratitis. In: Medical Mycology, 3rd ed. Philadelphia: Lea & Febiger, 1977: 485-487. 5. Thind TS, Agarwal SC. Studies on keratin degradation by some soil inhabiting keratinophilic fungi. Proceedings of the National Academy of Sciences, India 1976; B 46 (4): 515-518.
Paronychia and black discoloration of a thumb nail caused by Curvularia lunata A. Kamalam, K. Ajithadass, G. Sentamilselvi & A.S. Thambiah
Mycology Section, Department of Dermatology, Madras Medical College and Government General Hospital, Madras 600 003, India Received 18 April 1991; accepted in revisedform 29 August 1991
Key words: Black nail, clotrimazole, Curvularia lunata, paronychia
Abstract
Chronic paronychia associated with black discoloration of the left thumb nail in a 51 year old female caused by Curvularia lunata is reported for the first time. The keratolytic activity of the fungus in the nail and its complete clearance by topical clotrimazole are reported.
Introduction
Paronychia is an acute or chronic inflammatory disorder of the nail folds. The nail changes associated with paronychia are secondary to the inflammation of the nail folds, particularly the proximal fold under which the nail matrix is placed. The etiologic factors involved may be primary or secondary. The primary causes are often traumatic such as simple injury or 'hang nail' or maceration following thumb sucking or frequent soaking in water, soaps, detergents, alcohol, vinegar, fruit juices, salt and sugar solutions and hence occupational. Sometimes a spirochetal, Treponema pallidum, infection may present as primary paronychia [1]. The secondary causes are by such bacteria as Staphylococcus aureus, S. albus, Streptococci group A, Escherichia coIi, Pseudomonas aeruginosa and Proteus vulgaris, and fungi such as Candida albicans. It should be emphasised that there is always a primary predisposing cause for these symptomatic secondary infections. Successful treatment is achieved when
these factors are considered along with the infections. Bacterial and fungal infections either singly or in combinations produce inflammation and swelling of the nail folds and deformity of the affected nail in the form of transverse grooves (Beau's lines). The swollen nail folds become separated from the nail plate and produce pockets which allow collection of water and other contactants including bacteria and fungi. This process results in painful discharges from such a site. The present report is of a patient with chronic paronychia and black discoloration of the nail caused by Curvularia lunata. Such an infection caused by this dematiaceous fungus has not been reported previously.
Case report
A 51 year old housewife was seen with a mild painful paronychia and black discoloration of the
84 twice daily for 2 months by which time the black color disappeared and the inflammation subsided.
Discussion
Fig. 1. Paronychia with black discoloration of the left thumb nail due to Curvularia lunata.
nail of her left thumb (Fig. 1) of 3 months duration. No treatment had been instituted previously for this condition. Scraping from the black area of the nail surface and the region beneath the cuticle showed brown septate conidia in 10% KOH mount and grew grey brown to olivaceous black colonies in profusion with aerial mycelium on Sabouraud's dextrose agar within 4 days. Culture mounts in lactophenol cotton blue showed brown, septate, branched mycelium and smooth, thick-walled, multiseptate conidia. These conidia showed 3 septa with a larger sub-apical cell and a typically curved outline characteristic of C. lunata. The nail scrapings in slide culture on corn meal agar also showed similar brown conidia germinating from the nail cells to produce hyphae, conidiophores and the typical conidia of C. lunata. The patient was advised to keep away from water, detergents and household work as much as possible and to use rubber gloves over cotton gloves while handling water, detergents etc. Topical 1% clotrimazole liquid was applied
Although brown and green discolorations of nails due to bacteria and C. albicans have been observed in association with paronychia, black color was not met with in our previous cases of onychomycosis. The present case is the first of its kind. This is also the first time C. lunata has been isolated from black nails. This agent has been isolated from the soil and plants of South India [2] and is a rare agent of mycetoma [3] and mycotic keratitis [4]. The brown septate conidia and hyphae observed in the nail scrapings of the present case have been frequently encountered in some skin lesions resembling tinea and eczema in our patients. Routine culture in future nail cases would give interesting and useful information as to how many of them are caused by C. lunata, since the keratolytic action of Curvularia species has been reported by some investigators [5]. The beneficial effect of clotrimazole is encouraging in paronychia and associated onychomycosis with black nails.
References 1. Stokes JH, Garner VC. The landmarks of late syphilis on skin and mucous membrane. In: Stokes JH, ed. Modern Clinical Syphilology. Philadelphia: WB Saunders, 1934: 771-870. 2. Subramaniam CV. Systematic account. In: Hyphomycetes. New Delhi: Indian Council of Agricultural Research, 1977: 783 -785. 3. Rippon JW. Mycetoma. In: Medical Mycology, 3rd ed. Philadelphia: WB Saunders, 1988: 80-118. 4. Emmons CW, Binford CH, Utz JP, Kwong-Chung KJ. Mycotic Keratitis. In: Medical Mycology, 3rd ed. Philadelphia: Lea & Febiger, 1977: 485-487. 5. Thind TS, Agarwal SC. Studies on keratin degradation by some soil inhabiting keratinophilic fungi. Proceedings of the National Academy of Sciences, India 1976; B 46 (4): 515-518.
