Saturday, March 18, 2006
“NAILING DOWN A DIAGNOSIS”
Brian T. Maurer, Enfield, Connecticut
D.S. is a 72-year-old left-handed male with a three-year history of periungual inflammation coupled with periodic cracking, separation and nail loss on the 3rd, 4th and 5th fingers of the left hand. The pads of these fingers also appear erythematous and swollen with dry cracked skin.
Initially, a local dermatologist prescribed topical Lamisil without effect. A subsequent month-long course of oral griseofulvin likewise did nothing. The periungual inflammation seemed to respond to topical erythromycin; the patient reports that all symptoms subsided over the summer months, only to return with the cold autumn weather.
An amateur gardener and golfer, D.S. wears a golf glove on his left hand during summer golfing season (when the condition seems to subside). He reports that his left hand usually feels colder than the right in winter time.
With the exception of one discolored nail of the left great toe, the nails of his remaining fingers and toes appear normal; he exhibits no other form of dermatitis.
Questions: Given the history and clinical course, what is the diagnosis? Suggestions for treatment?