Longitudinal Erythronychia of the Fingernail

Abstract

A man in his 70s presented to the clinic with a split in the right fifth fingernail for the past 10 years. He reported paroxysmal, intermittent pain that was exacerbated by cold weather. He fractured the digit more than 30 years earlier. Physical examination revealed distal nail plate splitting with accompanying longitudinal erythronychia (Figure , A) and tenderness on palpation of the nail unit. Magnetic resonance imaging revealed a nail matrix lesion (Figure , B), which was excised using a transungual approach with partial nail avulsion. The specimen was analyzed by histopathology (Figure, C and D). Histopathologic image D Histopathologic image C Magnetic resonance image B Physical examination A Figure. A, Right fifth fingernail with distal nail plate splitting and longitudinal erythronychia. B, Magnetic resonance image shows localization of the tumor to the nail matrix. C, Hematoxylin-eosin stain (original magnification ×4). D, Hematoxylin-eosin stain (original magnification ×20). WHAT IS YOUR DIAGNOSIS? A. Amelanotic melanoma B. Onychopapilloma C. Glomus tumor D. Squamous cell carcinoma in situ Clinical Review & Education

Expanding the Differential Diagnosis of the Painful Nail: A Case of an Onychopapilloma with Neuroma

“…In a retrospective single-center study of 65 patients who underwent nail biopsy for LE, onychopapilloma was the most common cause, diagnosed in 67% of monodactylous LE cases (41/61) [ 5 ]. However, other benign conditions and tumors, including glomus tumor, verruca vulgaris, lichen planus, warty dyskeratoma, and malignant neoplasms, such as Bowen’s disease, squamous cell carcinoma, and amelanotic melanoma, must be considered in the differential diagnosis of localized LE [ 6 , 7 ]. Surgical excision with histological confirmation is often required for diagnosis as clinical and dermoscopic features cannot rule out malignancy [ 6 ].…”

Transillumination: A Diagnostic Tool to Assess Subungual Glomus Tumors

“…Further diagnostic tests include the Love’s pin test, that is, identification of pain if the patient withdraws the finger, and the Hildreth’s test, that is, negativity of Love’s pin test after using a medical tourniquet [1]. On physical examination, a small, round, bluish nodule on the nail plate or less commonly a longitudinal erythronychia may be evident, while nail plate dermoscopy may show a pinkish structureless pattern with arborizing vessels [2, 4, 5]. Since surgical removal constitutes the only recommended treatment, a precise preoperative assessment and localization of the tumor are essential, enabling a complete excision with low risk of recurrence.…”

“…Although they may affect any area of the body, 75% of them occur in the hand and are mainly localized in the subungual region, accounting for about 1–2% of all hand tumors [1]. The diagnosis is mainly based on clinical symptoms, including paroxysmal pain, tenderness, and cold intolerance, given that clinical signs may be very subtle or even absent and imaging studies may fail to visualize tumors <2 mm in diameter [2]. Transillumination of fingertip has been described as a diagnostic tool for nailbed pathologies [3].…”

A novel cause of localized longitudinal erythronychia: infantile haemangioma of the nail unit

“…Onychopapilloma is the most common diagnosis of LLE, 1 but other causes, including glomus tumour, amelanotic melanoma and squamous cell carcinoma, should also be considered. 2 Most cases of LLE share a common pathogenesis, with the distal matrix disease process resulting in a longitudinal groove of the ventral nail plate, followed by the nail bed swelling into this space, which is identified as a visible erythronychia through the thinned plate. 3 Other associated presentations include distal subungual hyperkeratosis, splinter haemorrhage, focal onycholysis or a distal V-shaped notch.…”

“…The large fibres of the spinal nerves are more sensitive to compression, and it is theorized that in NP, compression of these fibres leads to reduced inhibition of the small nerve fibres that transmit itch sensation. 2 Consequently, the small nerve fibres are hyperstimulated, causing an itch sensation in the absence of stimuli. We report a case of NP caused by long-term poor posture as a result of our patient's occupation.…”