Green Nail Syndrome (Pseudomonas aeruginosa Nail Infection): Two Cases Successfully Treated with Topical Nadifloxacin, an Acne Medication

Müller, Simon; Ebnöther, M; Itin, Peter

doi:10.1159/000365863

Cited by 17 publications

(16 citation statements)

References 8 publications

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Section: Discussionsupporting

confidence: 87%

“…First of all, our study confirmed the previous findings that GNS tends to occur on a single digit, on the big toe or thumb, and with a significant association with onychomycosis 2,7 . While multiple GNS cases have been reported to be associated with Candida infection, 8–10 the specific number of these cases could not be identified in the present study due to insufficient description of the mycological examinations. Our data also revealed that there is no sex difference among the affected patients and that fluoroquinolones have good therapeutic efficacy, with 22 (64.7%) patients showing complete clearance and eight (23.5%) showing notable improvement before they were lost to the follow up; it should be noted, however, that onychomycosis can be a predisposing factor of GNS as P. aeruginosa is an opportunistic pathogen.…”

Section: Discussionsupporting

confidence: 87%

“…Pseudomonas aeruginosa is the causative bacterium of GNS with its metabolite, pyocyanin, causing the greenish chromonychia. Predisposing factors for GNS include frequent water exposure, onycholysis, preceding trauma, and onychomycosis 2,3 . While GNS may seem easily recognizable due to its distinctive color, some can be confusing in the real‐world setting, especially when the bacterial culture result is inconsistent.…”

Section: Introductionmentioning

confidence: 99%

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Clinical analysis of Pseudomonas aeruginosa‐positive and ‐negative green nail syndrome cases: A single center retrospective analysis

Lee

Mun

Cho

et al. 2021

The Journal of Dermatology

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Green nail syndrome (GNS) is a paronychial infection mainly due to Pseudomonas aeruginosa, characterized by green discoloration of the nail plate. Although the diagnosis of GNS may be straightforward with its distinctive color change, the clinical management of the disease can be sometimes confusing, especially when the bacterial culture result is inconsistent. There is, however, a paucity of comprehensive reviews regarding the treatment of GNS in the actual clinical setting. In this retrospective review of 34 patients, we found that GNS mostly occurs on a single digit (79.4%) on the big toe or thumb (85.3%) with frequent concurrent fungal infection (67.6%). The prevalence of inconsistent bacterial culture result with no evidence of P. aeruginosa was unexpectedly high (n = 22, 64.7%), in which case coagulase‐negative staphylococci were most frequently detected. The P. aeruginosa‐negative group did not demonstrate any statistically significant differences compared with the P. aeruginosa‐positive group, and it still responded well to the typical topical and/or oral fluoroquinolone treatment. GNS without the evidence of P. aeruginosa may be a more common occurrence than reported in the literature, and it can be managed successfully with the same strategy employed to treat P. aeruginosa‐positive cases. It may result from the low detection rate of P. aeruginosa due to the limited sensitivity of the test, or inadequate amount and/or contamination of the sample, warranting close scrutiny by clinicians.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Clinical analysis of Pseudomonas aeruginosa‐positive and ‐negative green nail syndrome cases: A single center retrospective analysis

Lee

Mun

Cho

et al. 2021

The Journal of Dermatology

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“…Table 1 lists the drugs used to treat acne by topical application of nanoparticle systems. These new formulations have been shown to provide efficacy, tolerability, compliance, and cosmetic acceptability [72,73]. …”

Section: Topical Applications Of Nanoparticlesmentioning

confidence: 99%

Nanoparticles and nanofibers for topical drug delivery

Goyal

Macri

Kaplan

et al. 2016

Journal of Controlled Release

443

227

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This review provides the first comprehensive overview of the use of both nanoparticles and nanofibers for topical drug delivery. Researchers have explored the use of nanotechnology, specifically nanoparticles and nanofibers, as drug delivery systems for topical and transdermal applications. This approach employs increased drug concentration in the carrier, in order to increase drug flux into and through the skin. Both nanoparticles and nanofibers can be used to deliver hydrophobic and hydrophilic drugs and are capable of controlled release for a prolonged period of time. The examples presented provide significant evidence that this area of research has—and will continue to have — a profound impact on both clinical outcomes and the development of new products.

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“…He was started on topical polymyxin B cream for 2 months with a view to extend treatment depending on progress. Other treatment options for Pseudomonas nail infections such as topical nadifloxacin18 and tobramycin drops19 have been reported, but they were not available in Canada.…”

Section: Treatmentmentioning

confidence: 99%

A chemical mixer with dark-green nails

Leung

Harding

2015

BMJ Case Reports

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Nails are integral extensions of the skin and they together form the largest organ of the human body. Changes in nail appearance can be due to external insults or internal pathologies, and nail signs have to be interpreted in light of a good history. We present an interesting case of a man who developed dark-green discolouration of his nails over a short period of time. His work as a chemical mixer rendered him susceptible to hazardous chemical exposure. A notification was filed and the local Occupational Health Department discovered insufficient protective gear and lack of protocols regarding hazards of isocyanate-based resin. The patient also reported washing utensils with bare hands. Based on the meniscal demarcation borders between the discoloured and normal areas, plus a positive bacterial culture from nail clippings, the final diagnosis of isocyanate-resin-induced onycholysis with secondary Pseudomonas infection remained as the most likely clinical diagnosis.

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Green Nail Syndrome (Pseudomonas aeruginosa Nail Infection): Two Cases Successfully Treated with Topical Nadifloxacin, an Acne Medication

Cited by 17 publications

References 8 publications

Clinical analysis of Pseudomonas aeruginosa‐positive and ‐negative green nail syndrome cases: A single center retrospective analysis

Clinical analysis of Pseudomonas aeruginosa‐positive and ‐negative green nail syndrome cases: A single center retrospective analysis

Nanoparticles and nanofibers for topical drug delivery

A chemical mixer with dark-green nails

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