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The Impecunious Treatment for Chronic Paronychia and Ingrown Fingernails:

Back to the Future

Introduction:

Since the 1890s, topical gentian violet dye has been recognized as lethal to Staph aureus and Candida albicans by dermatologists,¹ internists² and pediatricians, but became unpopular after the advent of penicillin. Now that MRSA has become an increasingly difficult infectious disorder, gentian violet dye usefulness has been resurrected.^3,4,5, While the standard treatment for chronic paronychia has been surgical, by either resection of the proximal nail⁶ or doing an eponychial marsupialization,⁷we’ve found nonsurgical treatment by gentian violet dye is successful. This use has not been reported.

Materials and Methods:

For 30 years chronic paronychia patients referred for surgery to our practice have been treated with onlytopical gentian violet dye, an estimated 150 patients, applied daily with a cotton-tipped applicator for 7-14 days. None required surgery. Patients with ingrown fingernails and toenails were similarly treated with relief of pain and inflammation, but when caused by aberrant nail growth, surgery was necessary to avoid recurrence.

Discussion:

Flatt⁶ suggested chronic paronychia was caused by small portions of dead fingernail acting as a foreign body beneath the eponychium. Flatt⁶ and others (Green⁷) identified Staphylococcus aureus as the usual primary infection, with Candida albicans as the secondary colonization. Gentian violet is well known to be highly effective against gram-positive bacteria⁸ (including MRSA) and thrush (Candida albicans).

Results:

All chronic paronychia patients during this long interval had correction without surgery, even including those with Raynaud syndrome. If any had recurrence, they either treated it themselves (probably) or went elsewhere. Patients with ingrown nails also obtained pain relief, but those with aberrant nail growth required surgical correction to avoid recurrence. Two patients with chronic ingrown fingernail complaints did not completely resolve their inflammation and both were found to have squamous cell carcinoma.

Conclusions:

1. Typical chronic paronychia patients will respond to topical gentian violet dye treatment, and this inexpensive (impecunious) method should be attempted prior to the morbidity of surgery.
2. Ingrown fingernail inflammation and pain will respond to gentian violet treatment, but if due to aberrant nail growth surgical correction is warranted to prevent recurrence.
3. When chronic ingrown fingernail inflammation does not respond to gentian violet treatment, squamous cell carcinoma degeneration (Marjolin cancer) should be suspected.