Parakeratosis pustulosa (PP) is a cause of distal nail inflammation and nail dystrophy that affects a single digit. It is nonpruritic and minimally painful. This distal digital dactylitis is characterized by the lack of a cuticle along with erythematous swelling of the proximal and lateral nail folds. The distal free edge of the nail demonstrates hyperkeratosis while eczema of the nail bed causes onychomadesis (see Figure 5).