What clue points to the cause of these nail changes?

February 17, 2011

During a routine examination, these changes are noted on both thumbnails of a 56-year-old man. He denies any trauma or underlying diseases.


Case 3:
During a routine examination, these changes are noted on both thumbnails of a 56-year-old man. He denies any trauma or underlying diseases.

(Answer on next page.)

 

 

Case 3: Median nail dystrophy

Further questioning revealed that the patient had a compulsive habit of picking at his cuticle. Median nail dystrophy secondary to trauma, A, was diagnosed.

None of the other conditions in the differential are associated with median nail dystrophy. If the condition has not persisted too long and the picking has not scarred the nail matrix, the nails will grow out normally in some patients.

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