Radiologic examination of the hands revealed an exuberant periosteal reaction of the terminal phalanges, with anchor deformation of the terminal phalanx, which was most obvious on the first fingers bilaterally. Calcipotriene was applied twice daily to the periungual skin, with no improvement. Clobetasol propionate ointment was also applied to the same area, with no benefit. Treatment with oral methotrexate and then cyclosporine was ineffective. Nail ablation provided no lasting benefit, and there was no improvement with subungual triamcinolone therapy.
Severe Nail Dystrophy Associated With Painful Fingertips. Arch Dermatol. 2000;136(7):925-930. doi: