Saturday, September 22, 2007

Nail Abnormality in a young girl

This case was submitted by Dr Choon Siew Eng FRCP, a dermatologist from Johor Bahru, Malaysia

A 14-year-old Malay girl presented with a 7-month history of asymptomatic nail abnormality affecting all fingernails. Good general health. No previous of current skin problem or hair loss. No family history of skin problem. No personal or family history of atopy. No family history of autoimmune disease. No nail biting habit. Never varnish nails and no excessive wet work. No on any medication, traditional preparations or supplements.

All fingernails are abnormal ranging from mild horizontal lamellar dystropy, longitudinal, v-shaped, u-shaped and w-shaped sulci as shown in images with variable erythema at the edges of abnormalities. Majority of eponychium appeared normal. Lunula and periungual skin no capillary dilatation noted although some had streaky hyperpigmentation. No palmar erythema. Finger pulps, toe nails, scalp and oral mucosa normal. No other skin lesions

Laboratory: Fungal culture negative

Histopathology: Reject biopsy.

Diagnosis: Lichen Planus, Part of connective tissue disease,

Comments: Would appreciate help in diagnosis and suggestion on further investigations and management.

Questions: Am puzzled by how normal and healthy the unaffected parts of nails look. Had never seen such pattern of erythema. Have anyone seen similar abnormality? Is it justifiable to offer patient systemic steroid to prevent further nails damage and scarring without an histologic diagnosis?


  1. Looks like dorsal pterygium lichen planus. Thinning of posterior nail fold with winged shape erosion of the nail plate distally. However, do note that the deformity occurs in the middle part of most of all the nails. could this be a variant of median nail dystrophy? Unlikely to be onychotillomania though.

  2. I agree with Henry -- but do not have that much experience with these lesions. I almost never treat them. I'm going to forward this to a colleague with a special expertise and interest in nail disorders.


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