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August 1995

Nail Dystrophy

Author Affiliations

The Royal Free Hospital and School of Medicine, London, England

Arch Dermatol. 1995;131(8):956. doi:10.1001/archderm.1995.01690200095020

REPORT OF A CASE  An 81-year-old woman presented with an 18-month history of fragility of the fingernails and toenails with a tendency to splitting, associated with itching and numbness of the fingertips.There was symmetrical dystrophy of all nails, consisting of longitudinal ridging and splitting, which was more severe on the fingernails; some had almost complete destruction of the nail (Figure 1). A violaceous scaly eruption was seen on the fingertips (Figure 2).Investigations showed a normal blood cell count, liver function tests, calcium, erythrocyte sedimentation rate, and chest radiograph. Microscopy and culture of scrapings of the nails were negative for fungus. A biopsy specimen from the affected skin of the fingertip showed hyperkeratosis and parakeratosis with homogeneous eosinophilic material in the dermis (Figure 3, left), which, at higher power, was seen to be present in the walls of vessels (Figure 3, right).What is your diagnosis?Figure 1.Figure

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