HPI: 22 yo man with 4 mo history
of a nail dystrophy. It began with erythema and small pustules on finger tip. A few weeks later the nail started to look abnormal. No other skin lesions. This began after starting a new job at which he uses a "mouse" for many hours a day and he thought it might have traumatized his finger tip. A brother has "eczema" of the knees.
O/E: The right small finger nail is lusterless, dystrophic
and for the most part separated from the nail bed. There is some mild thickening.
No marked finger tip eczema at present, but mild erythema is noted.
Clinical Photo:
 |
| left and right index finger tips |
Lab: KOH negative.
Fungal Culture negative at two weeks.
Diagnosis: Nail dystrophy. Acrodermatitis continua vs. Psoriasis (probably latter)
Questions: What is your diagnosis? How would you treat this?
References:
Also we can consider onychoclavus by repeated trauma. This is usually localized in the hyponychium or distal nail bed. Cutting the overlying nail plate away will make the lesion visible and also relieve the pain, as the pressure will be reduced.
ReplyDeleteReference: The nail in dfferential diagnosis by Baran & Haneke