We have recently seen 9 patients who developed onychomadesis associated with pyogenic granuloma of the proximal nail fold after removal of a plaster cast. All patients were males, aged from 15 to 42 years, who had experienced a bone fracture treated with cast immobilization for 1 to 3 months. The fracture involved a finger phalanx in 3 patients, a metacarpal bone in 2 patients, and the wrist (Colles fracture) in 4 patients. All patients complained of moderate paresthesia and pain of the immobilized hand during cast wearing and developed painful fingernail inflammatory lesions 7 to 30 days after cast removal. According to the patients, development of the nail lesions was preceded by a temporary arrest of the nail growth of the affected finger in all patients and of an adjacent finger in 3 of them. The findings of clinical examinations revealed identical features in all patients: proximal nail detachment associated with protrusion of a bleeding vascular nodule from the proximal nail fold (Figure 1 and Figure 2). In one patient the nail plate was absent. In 2 of the 3 patients with phalanx fracture the lesions involved the same fingernail of the fractured digit, while in the other patient pyogenic granuloma developed in an unaffected digit close to the fractured one. In the 2 patients with metacarpal fractures, the involved finger did not correspond to the fractured metacarpal bone.
Tosti A, Piraccini BM, Camacho-Martinez F. Onychomadesis and Pyogenic Granuloma Following Cast Immobilization. Arch Dermatol. 2001;137(2):231-232. doi: