A 47-year-old woman presented with a 23-year history of a symmetrical eruption on both thumbs. There was no family or personal history of skin diseases. The eruption started in the fingernail region and spread proximally over the years. Physical examination revealed dystrophic fingernails and symmetrical erythematous, pustular, and scaly plaques covering both thumbs (Figure 1 and Figure 2). Movement of both thumbs was limited. The results of the rest of the physical examination and routine laboratory tests were unremarkable. Fungal cultures from the patient's fingernails and fungal and bacterial cultures from pustules were all negative. A punch biopsy specimen was obtained from a pustule (Figure 3).
Yerushalmi J, Grunwald MH, Hallel-Halevy D, Avinoach I, Halevy S. Chronic Pustular Eruption of the Thumbs. Arch Dermatol. 2000;136(7):925-930. doi: