Clinical findingsA 51‐year‐old man presented with an 18‐month history of nail discolouration. Dermatological examination revealed onycholysis, subungual hyperkeratosis, splinter haemorrhages and yellow discolouration on the first fingernail of the right hand. On the left hand, all five fingernails had yellow discolouration, onycholysis and subungual hyperkeratosis, and the first, second and fifth fingernails showed splinter haemorrhages and salmon patches (Fig. ). Similar findings were also noted on the toenails. The patient's medical history included a traumatic injury to his right upper arm about 24 years previously, resulting in permanent nerve damage. His medical history revealed that initially he had nail abnormalities on both the right and left hands but eventually all fingernails on the side of the nerve damage (right) improved, with complete disappearance of the discolouration.(a) Previous nerve injury to the right upper arm; (b) on the right hand, only the first was affected, due to double innervation by both the median and the radial nerve; (c) on the left hand, all fingernails had yellow discolouration, onycholysis and subungual hyperkeratosis, while three of the nails also had splinter haemorrhages and salmon patches.Histopathological findingsHistopathological examination revealed subungual hyperkeratosis beneath the nail plate, neutrophilic microabscesses in the hyperkeratotic layer, and marked psoriasiform acanthosis,
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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