Patients with Pseudomonas aeruginosa infection of the nail plate complain of blue–green changes or of a sickly sweet, “fruity” smell similar to that of rotting grapes (Fig. 72-1). The blue–green pattern may occur in sequential transverse bands reflecting intermittent intensity of infection. Sometimes, the paronychial areas swell. In general, this is an indolent condition. This problem occurs in individuals whose hands are frequently wet.