Candidal onychomycosis

• candida is a relatively uncommon cause of onychomycosis, which is much more likely to be due to dermatophyte (ringworm) fungi
• in general onychomycosis does not paronychia, although both may be present if the infection is due to Candida; the surface of the nail plate is generally smooth but there is marked hyperkeratosis under the nail
• candidal onychomycosis is most likely when there is peripheral vascular disease (such as Raynaud's phenomenon), when there is a previously damaged nail due to other causes, or there are risk factors for candida such as diabetes mellitus
• candida onychomycosis
  • symptoms: Candida onychomycosis is generally not symptomatic, apart from pressure effects of a thickened nail
    
    
  • site: usually affects fingernails rather than toenails
  • signs: onycholysis, hyperkeratosis, and discolouration. Affected nails are discoloured white, green, or occasionally black (although green or black discolouration usually suggests secondary bacterial infection rather than Candida)
  • investigations: nail clippings are necessary to make a diagnosis of Candida onychomycosis where there is no associated paronychia, particularly if distal

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Reference:

1. Prodigy Guidance (2002) - Candida - Skin and Nail