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The histologic sections showed a nodular lesion with a hyperkeratotic epidermis. The dermis contained a diffuse infiltrate of histiocytes, lymphocytes, and occasional neutrophils. The key feature was of scattered multinucleate giant cells with a “ground glass” eosinophilic cytoplasm.
Radiographic evaluation of the knees confirmed joint effusions without evidence of joint destruction or erosions. Laboratory investigations showed high-titer gliadin IgA and tissue transglutaminase IgA antibodies consistent with celiac disease. Treatment was commenced with methotrexate.
Asymptomatic Papules Over the Proximal Nail Fold in a Child—Diagnosis. Arch Dermatol. 2008;144(1):105–110. doi:10.1001/archdermatol.2007.12-b
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