TWO FINGERS of a 6-week-old infant were noted to be discolored, "black and red," following removal of mittens (Figure 1) that had been placed on both hands 48 hours earlier to prevent involuntary excoriations of the face by his fingernails. The infant's mother had been advised by her mother-in-law not to trim his fingernails because, according to Hispanic folklore, it is believed that trimming the fingernails of an infant younger than 40 days old may result in poor vision. The infant had exhibited no unusual fussiness or irritability during this time.
The distal phalanx of the left index finger appeared denuded with surrounding erythema (Figure 2). The distal phalanx of the right index finger was necrotic distal to a piece of thread attached circumferentially. Surgical debridement and amputation of the distal phalanx were required (Figure 3). The third toe of another infant with an earlier stage of the same problem is shown in Figure 4.
Wang M, Schott J, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 2001;155(4):515-516. doi:10.1001/archpedi.155.4.515