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September 2009

Linear Pruritic Eruption With Onychodystrophy in a 1-Year-Old Girl—Quiz Case

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Arch Dermatol. 2009;145(9):1053-1058. doi:10.1001/archdermatol.2009.185-a

A 1-year-old white girl presented with a 2-month history of a linear eruption on the dorsal side of the right great toe associated with onychodystrophy. The eruption was pruritic and also intermittently interfered with ambulation. Nail changes were simultaneously noted along the lateral aspect of the right great toenail. The patient had no history of immunizations. The parents applied several topical over-the-counter remedies, including antifungal agents and over-the-counter steroid cream, without relief. Her mother and siblings had a history of atopic dermatitis. Physical examination revealed an erythematous plaque with scale and crust in a linear distribution from the dorsal tarsal-metatarsal joint of the right great toe to the proximal nail fold. The entire nail exhibited longitudinal ridging, with the lateral portion of the nail showing significant thickening and splitting (Figure 1).The other toenails and fingernails were normal. A biopsy specimen was taken of the plaque (Figure 2 and Figure 3).

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