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Off-Center Fold
January 2008

Asymptomatic Papules Over the Proximal Nail Fold in a Child—Quiz Case

Author Affiliations


Arch Dermatol. 2008;144(1):105-110. doi:10.1001/archdermatol.2007.12-a

A 5-year-old girl developed asymptomatic growths over the distal digits and nail bed regions of both hands 1 year before presentation. Subsequently, uncomfortable nodules appeared on the toes bilaterally. More recently, she noticed swelling and discomfort of the knees. The family includes an unaffected sister, brother, and parents, although the brother has celiac disease.

Physical examination revealed multiple, 4- to 9-mm skin-colored nodules clustering around the nail beds (Figure 1). Both knees were swollen with a moderate-sized effusion. Further clinical examination revealed a short port-wine stain on the left lower leg area. Two 3-mm punch biopsy specimens were taken from the nodules on the left little finger nail bed and the left middle finger proximal interphalangeal joint (Figure 2 and Figure 3).

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