Onychodystrophy On Twenty Nails Caused By Candida Parapsilosis and Staphylococcus Aureus: A Case Report

Tutty Ariani


Introduction: Onychodystrophy can caused by variety of underlying diseases such as fungal and nonfungal infections, various noninfectious inflammatory dermatologic diseases of the nail unit and tumors.  To establish the underlying disease leading to nail dystrophy as a first step one should differentiate between infectious and noninfectious disorders by obtaining nail material for microscopic examination and culture.  Case Report: A case of onychodystrophy on twenty nail in 43 years old housewife woman was reported.  The chief complaint was all of her fingernails and toenails were brittle, the color became yellow brown blackish since 6 month ago and sometimes excreted smell discharge. There were onychodystrophy, onycholysis, subungual hyperkeratosis and yellow brown blackish discolorization of all fingernails and toenail on physical examination. There were longitudinal striae, aurora borealis pattern, jagged margin of proximal edge on dermoscopic examination. Microscopic examination of nail clipping and scrapping of fingernails with 20 % potassium hydroxide was negative. The culture of fungi showed Candida Parapsilosis. Culture of bacteria was Staphylococcus aureus. PAS stain from nail clipping resulted was Candida Spp. Patient treated with oral pulse antifungal itraconazole 2x200 mg/day combination with ciprofloxacin 2x500 mg twice a day and ketokonazol cream twice a day. Conclusion: Onychodystrophy can caused by onychomycosis aggravated by bacterial infection. Diagnosis of onychomycosis candida was made base on diagnosis, physical examination, microscopic, culture and histopatology. Predisposition factor in this patient was chronic exposure with water. There is improvement clinical appearance after therapy with antifungal and antibiotic


Onychodystrophy, Candida Onychomycosis, Trachyonychia, Onychoscopy, Nail PAS Stain

Full Text:



Schieke SM, Garg A. Superficial fungal infection. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, editors. Fitzpatrick Dermatology in general medicine. Eigth edition, volume two. New York: McGraw Hill; 2012: 2277-97.

Sobera JO, Elewski BE. Onychomycosis. In: Nails Diagnosis Therapy Surgery, Scher RK, Daniel III CR. Third Edition, USA; 2005:123-130

Oppel T, Korting HC. Onychodystrophy and it is management. German Medical Science ;2003:1-7

Narain U, Bajaj AK. Candida onychomycosis: Indian scenario. International Journal of Advanced Medicine. 2016 Aug;3(3):638-642

Gaya ML et al. A retrospective study of onychomycosis in dermatology and venereology outpatient clinic of Dr.M.Djamil Hospital Padang (January 2013-July 2016). In: Programme and abstract the 6th asia pacific society for medical mycology congress. Bali;2016:130

Elewski BE. Pseudomonas infection in a patient with onychomycosis. Journal of American Academy of Dermatology.1997;493-494

Gupta AK, Daniel CR. Factors that may affect the response of onychomycosis to oral antifungal therapy. Australasian Journal of Dermatology. 1998; 222-224

Grover C, Jakhar D. Diagnosticutility of onychoscopy review of literature. Indian Journal of Dermatopathology and Diagnostic Dermatology.2017;31-40

Piraccini BM, Balestri R, Starace M, Rech G. Nail digital dermoscopy (Onychoscopy) in the diagnosis of onychomycosis; Journal of the European Academy of Dermatology and Venereology ; 2011:1-5

Arca E et al. An open, randomized, comparative study of oral flukonazole, itraconazole and terbinafine therapy in onychomycosis. Journal of Dermatological Treatment;2002;13:3-9

Brown SJ. Efficacy of flukonazole for the treatment of onychomycosis. The annals of pharmacotherapy;2009:1684-1691

DOI: https://doi.org/10.33854/heme.v4i2.955

DOI (PDF): https://doi.org/10.33854/heme.v4i2.955.g400


  • There are currently no refbacks.

Copyright (c) 2022 Health and Medical Journal

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.