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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 .