Help with nail condition

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These are the nails of a twenty year old female. All siblings have the same condition. Father, plus brothers. She has eleven cousins all but one have the condition.

Px reports that it is not painfull, just unsightly. No history of psoriasis, no trauma known. Considering avulsion and sterilisation. Comments please? The condition is? Treatment options?

 

Thanks for the good pics. What was the diagnosis in the case of the father and the other siblings? Any relevant medical history? Any conditions of the fingernails? Any other family history? Did the paternal grandfather/mother have similar nails? Any history of localised malignancies? Any common drug history? Is the vascular and neurological status intact?

The skin striae around the dorsum of the hallux appear to be unusual and it is always best to reach a diagnosis before carrying out treatment, especially surgical treatment.

All the best

Bill Liggins

 

Hi Bill
In answer to your questions. As siblings are male, they seemed to accept the nails as "the family curse" there is one male cousin, that has normal nails. My patient is female,has normal strong healthy fingernails, is healthy, no asthma,thyroid,heart,lung, or known allergy, she takes no medication, is not athletic, weight is as per height BMI normal. Vascular status is excellent (both dorsal/planta digital pulses audible by doppler. Have not looked at neuro status.
I will re visit the mothers side, and the cousin with "normal" nails, check his parent status., My patient is of English parents, immigrated to Australia.
Thank you for your input.

 

Thanks Trevor

As a guess I think that you have found something rare, perhaps autosomal dominant periodical shedding, hereditary partial onycholysis, hidrotic type congenital ectodermal defect or other condition.

If the patient is worried by the nail and it causes problems/pain, everything else being within normal bounds then surgical t/t should not be a problem. However, this is definitely worth a paper and perhaps getting together with a dermatologist would be a good idea. Get famous!

All the best

Bill

 

Hi Bill,
Here is an update from the px and I quote from her email.

"We never got around to bringing my dad in to see you so here's two pictures of his toenails instead.
Also just to recap family history. People who have toenails the same as mine and people who have normal toenails from my dad's side of the family.


Grandpa YES
Uncle YES Aunt YES Aunt Normal ?? Dad YES
Male cousin Normal Female cousin Normal Me YES
Male cousin YES Sister YES


My sister and myself have sensitive skin and react badly to mozzie bites etc but have no skin complaints.
We've never seen a dermatologist.
The family is from West Coast of Scotland. Ayrshire originally (South of Glasgow)"


Any podiatrists from Ayrshire that have seen this before
Regards
Trevor

 

Quick question:

Any hx of alopecia in the family?

More later, gotta dash!

Bel

 

Me again.

Agree with Bill, this appears to be a rare autosomal dominant congenital condition. My first guess, which it can only be at best, is Pachyonychia Congenita (PC).
http://dermatologyforyou.com/conditions/pachyonychia.asp

PC is an uncommon genodermatosis characterised by dystrophic, thickened nails and usually associated with PPK. However, there have been cases cited where only the nails are affected;
http://www.ncbi.nlm.nih.gov/pubmed/18700115
http://www.ncbi.nlm.nih.gov/pubmed/10954990

My reason for enquiring about hair loss was that I recalled reading somewhere about trachyonychia (which usually involves all 20 nails) and alopecia. Can`t find it now, the closest article I have found is here;http://www.ncbi.nlm.nih.gov/pubmed/1918465

.....which also mentions another differential diagnosis; Lichen Planus (although LP is usually associated with thinning of nails and Onychoschizia - love that word)

http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=-857502612
http://archderm.ama-assn.org/cgi/content/full/137/8/1027/FIGDST00165F2

Treatment for any of the above is virtually non-existant and whilst it would be interesting to investigate the genetics in this case, I get the feeling that your pt just wants rid of what she perceives as unsightly nails. Maybe avulsion is the best way to go.

Cheers,
Bel

 

Take a sample of the nail..deep.You may get a positive fungal culture.If not,ask her medical history

 

Looks like a case of Wegie foot to me

(Pronounced Weegee - refers to anyone from the Glasgow area - glasWEGIan.)