Journal of Cosmetics, Dermatological Sciences and Applications, 2013, 3, 250-255
Published Online December 2013 (http://www.scirp.org/journal/jcdsa)
http://dx.doi.org/10.4236/jcdsa.2013.34038
Open Access JCDSA
Treatment of Chronic Paronychia: A Double Blind
Comparative Clinical Trial Using Singly Vaseline,
Nystatin and Fucidic Acid Ointment*
Khalifa E. Sharquie1#, Adil A. Noaimi2, Sunbul A. Galib3
1Scientific Council of Dermatology & Venereology, Iraqi Board for Medical Specializations, Department of Dermatology &
Venereology, College of Medicine, University of Baghdad, Baghdad, Iraq; 2Department of Dermatology & Venereology, College of
Medicine, University of Baghdad, Baghdad, Iraq; 3Department of Dermatology & Venereology, Baghdad Teaching Hospital, Bagh-
dad, Iraq.
Received September 12th, 2013; revised October 10th, 2013; accepted October 18th, 2013
Copyright © 2013 Khalifa E. Sharquie et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Chronic paronychia is a chronic inflammatory reaction of the proximal and lateral nail folds of multifac-
torial in etiology like irritant, bacterial and monilial causes. But housewife work is a major cause of chronic paronychia.
Objective: To assess the efficacy and prophylactic effects of Vaseline by occlusion of nail folds in comparison with
nystatin ointment and fucidic acid in treatment of housewife chronic paronychia. Patients and Methods: This double,
blinded, comparative therapeutic, clinical trial is conducted at the Department of Dermatology-Baghdad Teaching Hos-
pital from May 2010 to May 2011. Eighty female housewife patients with chronic paronychia were included in this trial.
They were divided into three groups according to the following therapeutic model: Group A treated by Vaseline con-
sisted of 40 patients; Group B and Group C treated by nystatin ointment, fucidic acid ointment respectively and each
group consisted of 20 patients. All demographic points related to the disease were recorded from all patients. Invented
score system was applied to assess the severity of disease and the response to therapy. Patients had used therapy twice
daily on the proximal and lateral nail folds. Treatment duration was 12 weeks. Results: Group A (Vaseline): The re-
covery rate after 12 weeks of treatment was 26 (65%) patients, while there was no recovery in 14 (35%) patients. Group
B (Nystatin ointment): The recovery rate after 12 weeks was 13 (65%) cases and there was no recovery in 7 (35%)
patients. Group C (Fucidic acid ointment): The recovery rate 12 weeks of treatment was 12 (60%) patients and there
was no recovery in 8 (40%) patients. The earliest signs of recovery in all groups were decreased in nail fold tenderness,
redness, swelling followed by improvement in the nail shape, then decreased in the separation of proximal nail fold from
nail bed followed by re-growth of cuticle. There was significant difference in clinical response before and after therapy
in all groups (P ≤ 0.0001) while there was no statistical significant difference when the three groups were compared
with each other (P = 0.784). Conclusions: Vaseline occlusion therapy of the nail folds in patient with chronic par-
onychia was enough to induce recovery from the disease and there was no statistical significant difference when com-
pared with nystatin or fucidic acid treatment of chronic paronychia.
Keywords: Housewife; Paronychia; Vaseline; Occlusive Therapy
1. Introduction
Chronic paronychia is a major health problem of which
housewife paronychia is the main type seen in daily
clinical practice [1].
The etiopathogenesis is multifactorial, but the wet con-
dition during housewife work will cause loss of nail cuti-
cle followed by separation of proximal and lateral nail
folds and this will make a dead space thus allowing the
entrance of water, detergents, bacteria under the nail
folds followed by inflammation leading to the main fea-
tures of chronic paronychia mainly swelling of the nail
folds, nail dystrophy; this is so-called wet theory [2].
*Disclosure: This study is an independent study and not funded by any
drug company.
#Corresponding author. Accordingly, the presence of candida and bacteria like

Treatment of Chronic Paronychia: A Double Blind Comparative Clinical Trial
Using Singly Vaseline, Nystatin and Fucidic Acid Ointment
251
Staph aureus, alpha, beta and gamma-haemolytic Strep-
tococci, Klebsiella pneumonia, Bacteroides species and
Coliform, Pseudomnas aeruginosa, Proteus species and
other organisms as Diphtheroids, Streptococcus fecalis,
and Staphphylococcus albus are considered as secondary
invader in the pathogenesis of chronic paronchia [3].
Hence, the aim of therapy is to close the so-called dead
space and encourage the adhesion of nail cuticle and nail
folds thus preventing the entrance of water, detergents
and bacteria. Therefore, the management of chronic par-
onychia should start by prevention of wet conditions and
giving antimicrobial agents to stop the process of in-
flammation, but unfortunately, many practicing derma-
tologists give antifungal, antibacterial drugs for long time
aiming to enhance cure but without stopping the wet
conditions, so recurrence is always high [2].
Still many housewives do not take the advice of wear-
ing gloves and again will prevent healing of chronic par-
onychia [4].
Accordingly, the aim of present work is to do occlu-
sion of the dead space by Vaseline alone compared with
using antimicrobial agents like fucidic acid and nystatin
and to record the therapeutic response to these therapies.
2. Patients and Methods
This double blind comparative therapeutic trial on the
effectiveness of two drugs topically applied on the nail
folds (nystatin and fucidic acid) compared with Vaseline
on treatment of housewife chronic paronychia. This was
conducted in the Department of Dermatology and Vene-
reology-Baghdad Teaching Hospital, Baghdad, Iraq from
May 2010-May 2011.
Eighty female patients with house wife chronic par-
onychia were enrolled in this study. Inclusion criteria
included all patients with housewife chronic paronychia
who attended for therapy. The diagnosis of chronic par-
onychia was established according to the following crite-
ria: housewife patients, absence of cuticle associated
with swelling and erythema of proximal and lateral nail
folds, separation of dorsal and lateral nail folds from nail
plate. While, exclusion criteria as follow: acute par-
onychia, infections like tinea unguam, warts, and her-
petic whitlow. Also, dermatological diseases that can
cause chronic paronychia such as pemphigus vulgaris,
psoriasis, and lichen planus, connective tissue diseases
like systemic lupus erythematosus, discoid lupus erythe-
matosus, dermatomyositis, and scleroderma were ex-
cluded. Peripheral vascular disease like perniosis, Bur-
ger᾽s disease, Raynaud᾽s disease, patients with immuno-
suppressive conditions, bone deformities, diabetes melli-
tus, and conditions requiring systemic or topical use of
corticosteroids, calcineurin inhibitors, retinoids and pro-
tease inhibitors were not included.
A full history was taken from each patient regarding
name, age, gender, marital status, residence, social status,
job, number of children, using of gloves and washing
machine, right or left hand, baking, smoking. Also dura-
tion, number of fingers involved, and type of treatment
used before.
All patients were examined regarding right or left hand
involvement or both, number of nails involved, presence
of swelling, tenderness, and purulent discharge, presence
of nail changes as buckled nail plates, transverse ridging,
nail discoloration and associated onycholysis or dystro-
phy.
Formal consent was taken from each patient before
starting the trial of treatment after full explanation of
nature of disease, course, prognosis, complications, na-
ture of drug, method of application, duration of treatment
and follow up and the ethical approval was obtained from
Scientific Council of Dermatology and Venereology,
Iraqi Board for Medical Specializations.
Evaluation of the patients was done to re-evaluate the
disease score and report any side effects from treatment
clinically and by photograph during study period of 12
weeks.
All patients were photographed by a digital camera as
a baseline and then on 12 weeks, in the same place with
fixed illumination and distance by using a digital camera
(Sony: Cyber shoot with resolution 12 mega pixels).
The following scoring system of the chronic par-
onychia was invented:
1) Loss of cuticle score = 1
2) Separation of proximal nail fold from nail bed with
different grades and this was measured by orange
stick introduced under the nail folds:
a. Separation just score = 1
b. Separation 2 mm score = 2
c. Separation > 2 mm score = 3
3) Swollen nail fold:
a. Swollen just score = 1
b. Swollen red score = 2
c. Swollen tender score = 3
4) Secondary nail changes:
a. Ridging score = 1
b. Dystrophy score = 3
When patients had multiple fingers involvement, the
severely affected one was scored only and the others al-
though treated they were not counted within scoring.
The treatment protocol: Patients were divided into 3
groups:
Group A: using topical white petrolatum (Vaseline®)
manufactured by Anglo-Dutch Company Unilever.
Group B: using topical nystatin ointment in Vaseline
base (Mycodin®) is manufactured by The State Company
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Treatment of Chronic Paronychia: A Double Blind Comparative Clinical Trial
Using Singly Vaseline, Nystatin and Fucidic Acid Ointment
Open Access JCDSA
252
for Drug Industries and Medical Appliances Ninavaha-
Iraq, under license of SDI Co.15 grams tube. Each gram
contains nystatin 100.000 I.U of the ointment.
Group C: using topical fucidic acid ointment in Vase-
line base (Fusibact™) manufactured by Jamjoom Pharma.
15 grams tube.
Each 100 gram of the ointment contains the active sub-
stance sodium fusidate, which corresponds to 2 gram
sodium fusidate.
The treatment was applied twice daily on the proximal
and lateral nail folds. Treatment duration was 12 weeks.
All patients were advised to avoid cuticle trimming, nail
biting, picking, trauma and also were encouraged to use
rubber gloves with inner cotton lining for household
tasks.
Statistical analysis was carried out using paired t-test
to compare differences before and after treatment in each
group. Chi–square test was used to check relations be-
tween results either recovery or no recovery. P value less
than 0.05 was considered significant. SPSS (statistical
package for social sciences) version 17 was used for the
analysis.
3. Results
Eighty housewife patients with chronic paronychia were
completed the study their ages ranged from 15 - 68 with
mean ± SD of 37.26 ± 11.06 years. The role of contrib-
uting factors showed that moisture; super hydration, de-
tergents and rough work played the highest role in dam-
aging the nail cuticle and nail folds in all patients. Dura-
tion of disease ranged from half year- 12 years with
mean± SD of 2.166 ± 2.66 years. Total numbers of 184
fingers involved in 3 groups. Number of finger involved
ranged from (1 - 8) with mean ± SD of 2 ± 9.61 fingers.
The nail changes in patients of chronic paronychia dem-
onstrated in (Table 1).
Patients in Group A were treated by White petrolatum
ointment; forty house wife patients were included in this
group, their ages ranged from 15 - 60 years with mean ±
SD of 36.37 ± 10.8 years. Married females were 32
(80%) patients. They had (0 - 8) children with mean of 4
children. Twenty seven (67.5%) patients were using
washing machine, while only 3 (7.5%) patients were us-
ing gloves. Twenty (50%) patients were baking regularly.
All of them were right handed 40 (100%). Duration of
disease ranged from less than 1 year - 12 years with
mean ± SD of 2.6 ± 3.44 years. Total number of 88 fin-
gers was involved.
Right hand alone was involved in 29 (72.5%), while
both right and left hands were involved in 11 (27.5%).
Number of finger involved ranged from (1 - 7) with
mean ± SD of 2 ± 1.55 finger. Seventeen (42.5%) pa-
tients with 1 finger involvement, 8 (20%) patients with 2
fingers, 8 (20%) patients with 3 fingers, 4 (10%) patients
with 4 fingers, 3 (7.5%) patients with 6 fingers. No any
side effect reported from treatment. Most commonly in-
volved finger in right hand was middle finger 22 (55%)
followed by thumb 19 (47.5%), ring finger 18 (45%),
index 13 (32.5%) with no little finger involvement.
While in left hand most common finger involved was
thumb 7 (17.5%), both middle and ring fingers 4 (10%)
and index only 1 (2.5%).
Patients in Group B were treated by nystatin ointment;
twenty house wife patients were included in this group,
their ages ranged from 19-55 years with mean ± SD of
37.40 ± 10.75 years. Married females were 18 (90%)
patients. They had (0 - 7) children with a mean of 3 chil-
dren. Twelve (60%) patients were using washing ma-
chine. Three (15%) patients were using gloves. Ten
(50%) patients were baking regularly.
All of them were right handed 20 (100%). Duration of
disease ranged from less than 1 year - 12 years with
Table 1. The nail changes in patients of chronic paronychia at presentation.
Group A (Vaseline) Group B (Nystatin ointment)Group C (Fucidic acid ointment)
No. % No. % No. %
Loss of cuticle 40 100 20 100 20 100
Nail fold swelling 40 100 20 100 20 100
Separation of nail fold from nail plate 40 100 20 100 20 100
Transverse ridging 39 95 20 100 20 100
Longitudinal ridging 8 20 2 10 2 10
Nail pitting 28 70 13 65 10 50
Onycholysis 8 20 1 5 2 10
Nail plate dystrophy 5 12.5 3 15 2 10
Color changes 34 85 17 85 15 75

Treatment of Chronic Paronychia: A Double Blind Comparative Clinical Trial
Using Singly Vaseline, Nystatin and Fucidic Acid Ointment
253
mean ± SD of 1.98 ± 2.74 years. Total number of 39 fin-
gers was involved. Number of finger involved ranged
from (1 - 8) with mean of ± SD of 2 ± 1.71 fingers, thir-
teen (65%) patients with 1 finger involvement, 2 (10%)
patients with 2 fingers, 3 (15%) patients with 3 fingers, 1
(5%) patient with 4 fingers, 1 (5%) patient with 8 fingers.
No any side effect reported from treatment. Right hand
alone was involved in 13 (65%), left hand was involved
in 2 (5%), while both right and left hands were involved
in 5 (25%). Most commonly involved finger in right
hand was thumb 11 (55%) followed by ring finger 7
(35%), middle finger 5 (25%), index 4 (20%), little fin-
ger only 1 (5%), while in left hand most common finger
involved was middle 4 (20%), followed by index 3
(15%), then both ring and thumb 2 (10%) for each one
while little finger was not involved.
Patients in Group C were treated by fucidic acid oint-
ment; twenty house wife patients were included in this
group, their ages ranged from 22 - 68 years with mean ±
SD of 38.90 ± 12.195 years. Married females were 19
(95%) patients; they had (0 - 8) children with a mean of 4
children.
Eleven (55%) patients were using washing machine.
One (5%) patient was using gloves. Nine (45%) patients
were baking regularly. All of them were right handed 20
(100%). Duration of disease ranged from less than 1 year
- 10 years with mean ± SD of 2.035 ± 2.178 years. Total
number of 57 fingers was involved.
Number of finger involved ranged from (1 - 6) with
mean of ± SD of 3 ± 1.576 fingers, four (20%) patients
with 1 finger involvement, 7 (35%) patients with 2 fin-
gers, 3 (15%) patients with 3 fingers, 3 (15%) patients
with 4 fingers, 1 (5%) patient with 5 fingers, 2 (10%)
patients with 6 fingers. No any side effect reported from
treatment. Right hand alone was involved in 12 (60%),
while both right and left hands were involved in 8 (40%).
Most commonly involved finger in right hand was thumb
16 (80%) followed by index and middle fingers 10 (50%)
for each finger, then ring finger 5 (25%), little finger
only 1 (5%), while in left hand most common finger in-
volved was thumb 6 (30%), followed by index 4 (20%),
then middle 3 (15%) lastly ring finger was 2 (10%).
Clinical Response
According to the present study results we can divide pa-
tients in each group into: patients with recovery and pa-
tient without recovery.
1. Recovery: either cured: re-growth of cuticle, no sepa-
ration of nail folds from nail bed, normal proximal
nail fold, nail plate grows normally or improved: ab-
sence of cuticle, nail folds just separated from nail
bed, normal proximal nail fold, nail plate grows nor-
mally (score = 0 - 2).
2. No recovery: either stable: absence of cuticle, nail
folds separated from nail bed > 2 mm, proximal nail
folds just swollen, abnormal nail plate (ridging, dys-
trophy) or worse: absence of cuticle, nail fold sepa-
rated from nail bed > 2 mm, proximal nail fold swol-
len tender, abnormal nail plate (ridging, dystrophy)
with purulent inflammation of the proximal nail fold
(score = 3 - 11).
There were highly statistically significant differences
in recovery of paronychia in all groups when we com-
pared the scoring before and after therapy after 3 months
of treatment (P ≤ 0000.1) (Table 2 and Figure 1).
When the three groups where compared between each
other, there was no significant statically difference in
recovery rate between them (P = 0.784) (Table 3).
4. Discussion
Chronic paronychia is an inflammatory dermatosis of the
nail folds, with secondary effects on the nail matrix; nail
growth and soft-tissue attachments [5].
The etiology of chronic paronychia is multifactorial in
origin [6]. Infection by multipule organism, especially-
yeasts (commonly Candida albicans) and intestinal bac-
Table 2. The recovery of chronic paronychia patients be-
fore and after therapy in the 3 groups.
Group Range
of score
Mean
of score
St.
dev. t-test P-value
A Before7 - 11 8.10 1.150
VaselineAfter0 - 11 3.65 2.627
10.779 <0.0001
B Before5 - 11 7.85 1.348
NystatinAfter0 - 10 3.60 2.945
6.514 <0.0001
C Before6 - 11 8.15 1.348
FucidinAfter0 - 8 3.70 2.452
5.973 <0.0001
Table 3. The clinical response to treatments in the 3 groups.
Group
Group A
(Vaseline)
Group B
(Nystatin)
Group C
(Fucidin)
No.% No. % No. %
Recovery rate 2665 13 65 12 60
No recovery rate 1435 7 35 8 40
Total 40100 20 100 20 100
Value Df P value
Chi-Square (x2) 0.487 2 0.784
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Treatment of Chronic Paronychia: A Double Blind Comparative Clinical Trial
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254
(a)
(b)
(c)
Figure 1. Chronic paronychia in the right thumb in a
housewife before and after treatment by topical Vaseline. (a)
At presentation; (b) At 6 weeks after treatment; (c) At 12
weeks after treatment.
teria, is proposed to be a major etiologic factor, but re-
cent studies have established the pivotal role of irritants
and allergens in the development of chronic paronychia
[7].
Chronic paronychia is a major health problem among
Iraqi house wife dermatoses as it accounts for 33.3% of
the whole occupational housewife dermatoses [2].
It is well established that house wife work is the main
etiological factor in the etiopathogenesis of chronic par-
onychia where it works through the following factors: the
wet condition and the trauma of house work will cause
loss of nail cuticle followed by separation of proximal
and lateral nail folds this will allow water, detergents,
bacteria to enter under the nail folds followed inflamma-
tion leading to the main features of chronic paronychia
mainly swelling of the nail folds, nail dystrophy, this is
so called wet theory [2].
Sharquie et al. performed a study in 1990 on microbi-
ology of chronic paronychia in Iraqi housewives. [2] The
primary isolation from cultures on Sabouraud᾽s agar
showed Candida organisms in 93.3% of the cases, of
which 88.3% were Candida albicans, while the bacterial
isolates were mainly: Coliform in 33.3%, Pseudomnas
aeruginosa plus coliform in 26.6%, Proteus species plus
coliforms in 8.3%, Staphylococcus aureus 16.6%, and
other organisms as Diphtheroids, Streptococcus fecalis,
and Staphphylococcus albus [2]. And these findings were
supported by further studies [8].
But presence of these bacteria and candida might play
secondary role in the pathogenesis of paronychia [2]. So,
the therapy of chronic paronychia is mainly through pre-
vention of house work through wearing gloves. Still
many dermatologists use antibacterial and antifungal
therapy for long time to treat chronic paronychia but in
most of cases there is a failure of treatment [2]. So, the
aim of present work is the treatment of paronychia just
through using any ointment like Vaseline to block the
entrance of detergents and bacteria under the nail folds
and to the dead space under these folds. And this treat-
ment was compared with topical antifungal and antim-
icrobial agents.
The results of present study showed that using Vase-
line, nystatin or fucidic acid where highly statistically
significant effective in clearing paronychia (P ≤ 0.0001),
when these groups where compared with each other there
was no statistically difference (P = 0.784).
The group that used Vaseline showed the following
results: recovery rate was 26 (65%) patients, while there
was no recovery in 14 (35%) patients, while patients in
nystatin group showed recovery rate in 13 (65%) pa-
tients, while there was no recovery in 7 (35%) patients.
While, patients on fucidic acid ointment gave recovery
rate in 12 (60%) patients, while there was no recovery in
8 (40%) patients. Accordingly, the present study had
proved that occlusion of nail folds from wetting condi-
tion through using Vaseline or antimonilial ointment or
antibacterial ointment was enough to clear signs and
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Treatment of Chronic Paronychia: A Double Blind Comparative Clinical Trial
Using Singly Vaseline, Nystatin and Fucidic Acid Ointment
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255
symptoms of paronychia and even might prevent the re-
lapse of the disease through ointment. The present re-
search to the best of our knowledge is the first one that
has been carried out in the field of chronic paronychia.
5. Conclusion
In conclusion, treatment of paronychia by occlusive
therapy using Vaseline alone is enough to induce recov-
ery and clearance of housewife paronychia.
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