Paronychia and onychomadesis due to pemphigus vulgaris

Sushil S Savant¹ , Anupam Das² , Piyush Kumar¹

¹ Department of Dermatology, Katihar Medical College and Hospital, Katihar, Bihar, India
² Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India

Correspondence Address:
Piyush Kumar
Department of Dermatology, Katihar Medical College and Hospital, Karim Bagh, Katihar - 854 105, Bihar
India

A 35-year-old man with pemphigus vulgaris developed erythema, edema and pustules on the proximal and lateral nail folds of several fingernails and toenails. Onychomadesis affecting multiple digits was noted [Figure - 1]a. Gram-stain and potassium hydroxide preparations of nail drainage were negative. A biopsy specimen of the nail bed of the right great toe revealed acantholysis [Figure - 1]b. Biopsy from proximal nail fold revealed suprabasal split. Thus, a diagnosis of paronychia and onychomadesis due to pemphigus vulgaris was made. Nail unit involvement in pemphigus vulgaris is rather common and is associated with both increased duration and severity of disease.

Figure 1: (a) Onychomadesis affecting multiple fingernails. (b) Nail bed showing acantholysis (H and E, ×400)

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