I have been experiencing terrible pain in my fingertip. My company nurse told me I had paronychia. What causes this, and how can I get rid of the awful pain? She suggested Tinactin, for an antifungal cream. I have been using this for the past three days, but with no improvement.

F.L.

Paronychia is an infection adjacent to a nail. There are two main types of paronychia, acute and chronic. Acute paronychia is typically caused by bacteria, such as strep (streptococci) or staph (staphylococci). In many cases, the infection involves several different organisms. An ingrown toenail, where the nail presses into the adjacent skin, can lead to a similar infection of a toe. In acute paronychia, intense pain develops over a day or two, and the skin next to the nail becomes swollen and tender. Sometimes the tissue under the cuticles becomes red and swollen, as well. The condition usually begins after an injury to the area, such as from a splinter or from biting one's nails. Pus accumulates, and the infection can spread deeper into the finger and may even involve the bone. To treat this condition, the doctor inserts a scalpel between the cuticle and the nail bed to drain the pus.

The more chronic form of paronychia typically is caused by a common yeastlike fungus called Candida, which is the same organism that causes vaginal yeast infections and an infection of the mouth called thrush. Candida also can cause skin infections, particularly in moist, warm areas such as the groin. People who frequently immerse their hands in water are susceptible to developing Candida-related paronychia, and bartenders, dishwashers and thumb-suckers are at particular risk. Unlike the acute bacterial form of paronychia, chronic paronychia usually progresses more slowly, over several days, and typically does not involves a large amount of pus. Untreated, the infection can spread to the nail itself, causing onychomycosis, a persistent infection that is very difficult to eradicate. Treatment of chronic paronychia involves keeping the fingers as dry as possible and applying an antifungal lotion to the affected area for several weeks.

Tinactin (tolnaftate) is an antifungal cream, so I am sure that your company nurse thought that you had candidal paronychia. Unfortunately, Tinactin, which is used to treat fungal infections such as ringworm and athlete's foot, usually is not effective against Candida. I would suggest you see a physician to confirm the diagnosis. If your condition proves to be candidal paronychia, he or she will likely recommend one of the azole creams, such as clotrimazole (Lotrimin and others).