Chloronychia in Healthcare Workers in COVID-19 Times.

Dear Editor,

A recent study published that 80% of 61 patients hospitalized in the intensive care unit for COVID-19 acute respiratory infection had bronchial aspirates positive for Pseudomonas aeruginosa [1]. On the other hand, no P. aeruginosa infection has been reported affecting the skin of patients or of healthcare providers.

It is well known today that variable skin disorders are induced by protective equipment such as facemasks and gloves. Prolonged use of gloves can cause hyperhidrosis, moisture, and humid areas, which can favor colonization of P. aeruginosa. P. aeruginosais named “the water bug” because it does survive only in humid environments.

P. aeruginosa is a Gram-negative aerobic coccobacillus, which is not part of the normal skin flora and, in immunocompetent individuals, does not cause any skin infection. In immunosuppressed patients, P. aeruginosacan be the pathogen causingpneumonia, osteomyelitis, and even sepsis [2].

P. aeruginosa nail infection is quite characteristic due to blue-green discoloration of the nail plate caused by two pigments: pyocyanin and pyoverdin (Fig. 1).

Fig. 1

Blue-green discoloration of the nail plate (the nail has become onycholytic, according to the patient's history, only after the color change had been noted).

Chloronychia observed in healthcare workers can be explained by the humid environment and possible associated nail lesions, but could it be a risk factor for immunosuppressed patients? P. aeruginosa can easily spread due to scratching and cause soft tissue infections such as ecthyma gangrenosum or necrotizing gangrene in immunocompromized individuals.

P. aeruginosa nail infection could be an occupational skin disease among healthcare providers, but it may also be a concern by spreading the infection to others, especially to hospitalized patients in COVID-19 units.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

The authors did not receive any funding.

Author Contributions

All authors equally contributed to this work.