Author Affiliations: Departments of Dermatology (Drs Shackelton and English) and Orthopedics (Dr Goitz), University of Pittsburgh, Pittsburgh, Pennsylvania.
A 56-year-old man with insulin-dependent diabetes presented with a 6-month history of deformity, discoloration, and discomfort of his right middle fingernail. He reported repeated reuse of the same lancet to check his blood glucose but otherwise denied any other trauma to the digit. Clinical examination revealed dusky gray discoloration of the distal lateral third of the nail plate as well as brown, subungual, hyperkeratotic debris (Figure 1A). Purulent discharge was apparent with compression of the nail plate.
Shackelton JB, Goitz RJ, English JC. Onychodystrophy With Associated Polymicrobial Distal Phalanx Osteomyelitis. Arch Dermatol. 2011;147(11):1330–1332. doi:10.1001/archdermatol.2011.302
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