Green nail syndrome due to Pseudomonas aeruginosa associated with acrylic nails: case report
Keywords:
Green nail syndrome; Pseudomonas aeruginosaAbstract
Introduction: Green nail syndrome, or chloronychia, is an infectious onychopathy characterized by green discoloration of the nail plate, predominantly caused by Pseudomonas aeruginosa. It is classically associated with occupational exposure to moisture, but cosmetic nail procedures such as acrylic nails have been recognized as an emerging risk factor.
Objective: To report a clinical case of extensive chloronychia secondary to acrylic nail application, highlighting its atypical non-inflammatory presentation, the usefulness of onychoscopy in diagnosis, and the effectiveness of combined therapeutic management.
Case presentation: A 26-year-old female patient presented with greenish discoloration of the nail of her left first toe, which began 15 days after acrylic nail application. Physical examination revealed extensive chloronychia with distal onycholysis, but no paronychia. Onychoscopy revealed a diffuse green pattern with subungual debris. Culture confirmed ciprofloxacin-sensitive Pseudomonas aeruginosa. A combination of hygiene measures, 1% acetic acid soaks, topical gentamicin, and oral ciprofloxacin was initiated. Complete resolution of the pigmentation was observed within one month, with definitive clinical cure confirmed at three months.
Conclusions: This case highlights that chloronychia can present extensively but not be inflammatory; cosmetic nail procedures are a relevant and preventable risk factor; onychoscopy is a key diagnostic tool; in cases with extensive involvement, a combined therapeutic approach (topical and systemic) can ensure rapid and lasting resolution.
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Copyright (c) 2026 Alvaro Rojas-Mora, Aylet Pérez-López , Tania Torriente-Esquivel , Graciela Fundora-Guerra
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