This client has a chronic paronychia with resultant nail dystrophy and possibly a habit tic deformity. You are right to have noticed that the cuticle is swollen or boggy. That is because the cuticle barrier has been compromised and when that occurs water can enter the nail unit. Once moisture accumulates, yeast will take up residence because yeast thrives in warm moist environments. The cuticle directly overlies the nail matrix and that is why the nail is growing in abnormally — because the matrix is what grows into the actual nail plate. Therefore any inflammation or trauma in the area of the cuticle is going to potentially result in a damaged nail. Your client’s cuticle is being compromised somehow. I would ask her if she pushes back on it with her index finger (habit tic). It is also possible that the cuticle is being removed. I always tell my patients that the cuticle is like the grout in your bathtub. It prevents water from seeping into the cracks. The cuticle is an important and amazing protective structure. Your client should not touch her cuticles and she should see a dermatologist. She will likely need a prescription medication to treat the current issue. The beauty of this diagnosis is that if treated properly, the nail will grow in normally.
— Dana Stern, M.D. is a board-certified dermatologist specializing in nails. She works in private practice in New York City.