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A 60-year-old man presented with a 2-year history of nail dystrophy, alopecia, and blisters and milia on his hands. Review of systems revealed weight loss, hoarseness, and dyspnea on exertion. Medical history included cardiac dysfunction, gastroesophageal reflux disease, and bilateral carpal-tunnel syndrome. Physical examination demonstrated atrophic scars with erosions and milia on the dorsal hands and diffuse alopecia of the scalp and eyebrows. Onychodystrophy of all 20 nails with longitudinal ridging and onychorrhexis, mimicking lichen planus, was also observed (Figure 1A and B).
Oberlin KE, Wei EX, Cho-Vega JH, Tosti A. Nail Changes of Systemic Amyloidosis After Bone-Marrow Transplantation in a Patient With Multiple Myeloma. JAMA Dermatol. Published online September 28, 2016. doi:10.1001/jamadermatol.2016.3178