A 43-year-old man presented for care of persistent nail dystrophy. He had been in good health until approximately 7 years before, when he first noted an erythematous pustular plaque on his fingertips. Within a week, paronychial and subungual involvement were noted on several fingers of both hands. Pus formed under the nail plate, and the lesions oozed, developing crusts that enveloped entire fingertips and nail dystrophy. Before being seen by us he had used numerous therapies without success. Among the treatments used were topical steroids, topical and oral antibiotics, and ultraviolet B phototherapy.
On physical examination the patient had thin, rough, and friable nails, and erythematous and scaly lesions on the fingertips (dorsal aspect of the terminal phalanges) of all fingers of both hands (Fig 1). There were no skin lesions elsewhere. Histologic sections from the skin lesion showed spongiform pustule of Kogoj. Roentgenograms of the patient's hands revealed no
Tsuji T, Nishimura M. Topically Administered Fluorouracil in Acrodermatitis Continua of Hallopeau. Arch Dermatol. 1991;127(1):27-28. doi:10.1001/archderm.1991.01680010031004