Green nail syndrome: updated review of an emerging disease in the era of COVID-19

ABSTRACT

Green nail syndrome or chloronychia is the infection of a damaged nail plate by Pseudomonas aeruginosa in a patient with an identifiable risk factor;the most frequently described are immunosuppression, a persistent moist environment and preexisting nail disease. Its diagnosis is relatively simple if the characteristic triad of green discoloration of the nail plate, chronic proximal paronychia and distal onycholysis can be observed, in cases of doubt a sample of the affected nail can be sent for cultures or histopathology. The cornerstone of treatment is the use of topical or systemic antibiotics along with measures to protect the nail from moisture. Prevention of this disease must be emphasized in health care personnel, especially in the context of frequent and rigorous handwashing practices implemented during the COVID-19 pandemic, since there are reports of nosocomial transmission of P.aeruginosa by health care professionals with nail infection.