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QUIZ SECTION ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Acquired Transverse Stripes on the Fingernails: A Quiz
Alya ALKHARS 1, Marion DELAPLACE 1, Muriel OUEDRAOGO 2 and Laurent MACHET 1, 3 *
1
Department of Dermatology, CHRU Tours, 2 CHU Yalgado, Ouagadougou, Burkina Faso, 3 PRES Centre, Val de Loire University, University Francois Rabelais de Tours, FR-37044 Tours, France. E-mail: machet @ univ-tours. fr
A 58-year-old woman presented in December 2016 with asymptomatic nails changes. She had had white-yellow transverse stripes on all the nails of both hands for several years( Fig. 1). She had noticed these nails changes for the first time in 2003, 3 weeks after travelling in a tropical area, and the lesions had improved spontaneously some months later. The nail lesions reappeared in 2011, when she began sailing every summer, from May to October, in the Mediterranean. Since then, the nail changes had been permanent. She noticed that that the bands moved with nail growth.
She was treated with levothyroxine for hypothyroidism and occasionally took paracetamol. She did not have any special manicures. Blood cell count, liver function tests and renal function tests were within normal limits.
Examination of the nails, including dermoscopy, revealed that all the fingernails were affected homogeneously, with non-palpable transverse white-yellow stripes 5 mm wide, and distal onycholysis of some of the nails. There was no evidence of matrix damage; the lunulae were normal. The lesions persisted after compression with the dermoscope.
High-resolution, 25 MHz, ultrasound revealed normal proximal nail fold, but loss of the normal“ rail-image”, consisting of a double hyperechoic band of nail plate with thickening and multi-lamellar appearance of the plate on affected transverse bands( Fig. 1 d, e).
What is your diagnosis? See next page for answer.
Fig. 1.( a) Right and( b) left hand showing nail bands and some distal onycholysis in December 2016. There was no inflammation of the nail matrix area. Blue arrows show the limits of nail stripe on one finger examined with ultrasound.( c) Left hand 3 months later. Note the distal progression of the bands.( d) Ultrasound appearance of normal nail in control. Note the“ rail image” of the normal nail plate.( e) Ultrasound image from the patient. Note the disruption in normal curve of the nail plate( blue arrow), the disappearance of normal rail image, and the thickening and multi-lamellar character of the nail plate in the affected area( red asterisk). doi: 10.2340 / 00015555-2850 Acta Derm Venereol 2018; 98: 386 – 387
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica.