PMC5821983_01
Clinical presentation of a 77-year-old patient with paronychia-like lesions and onychomadesis at tips of fingers and toes.
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Four months after treatment, he developed swelling of proximal nail folds and brittle nails of many fingers and toes resembling chronic paronychia, followed by nail detachment and crusted plaques on proximal and lateral nail folds (Figure 1).
Histopathology study (hematoxylin and eosin staining) demonstrated pseudoepitheliomatous hyperplasia of epidermis with eosinophilic spongiosis (a), intraepidermal eosinophilic microabscess with few acantholytic cells (b), and focal area of suprabasal separation (c).
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Few acantholytic cells and focal area of suprabasal separation were observed (Figure 2).
Direct immunofluorescence study showed positive IgG at the intercellular space of the epidermis.
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Direct immunofluorescence (DIF) study showed positive IgG and C3 at intercellular space of epidermis (Figure 3).