Tuesday, May 06, 2014

Median Nail Dystrophy

The patient is a 65 yo woman with a 3 month history of a medial split in the right thumb nail.  It is asymptomatic.  No history of trauma.

O/E:  The split begins at the proximal nail fold.  There is a suggestion of erythema at its proximal end.

Clinical Images:  Courtesy of Yoon Cohen

Diagnosis: Median nail Dystrophy.  Is this secondary to a subungual tumor?


Glomus tumor-induced longitudinal splitting of nail mimicking median canaliform dystrophy. Verma SB. Indian J Dermatol Venereol Leprol. 2008 May-Jun;74(3):257-9.
Abstract:Median canaliform deformity of the nail is an uncommon entity, where there is longitudinal splitting of the nail. Longitudinal splitting of the nail is a rare phenomenon and can also occur following number of growths arising in the nail matrix. On examination there was a longitudinal split in the nail plate, beginning in the distal nail fold and extending proximally all the way to the proximal nail fold. There was a small, almost indiscernible, swelling in that area, which was exquisitely tender. The split part of the nail showed a little discoloration. There was no discharge, bleeding, or subungual mass visible. 'Love test' was positive in this case. After nail avulsion, a small 2 mm x 4 mm nodule was exposed and excised. Histopathological examination of the tumor showed a mantle of glomus cells surrounding the blood vessels.  Free Full Text.

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