Mucous membrane pemphigoid-associated paronychia with onychomadesis

Abstract

BackgroundMucous membrane pemphigoid (MMP) is an autoimmune blistering disease that is notoriously difficult to treat. Nail involvement in MMP is rare.Case presentationWe report on a 58 years old man with severe MMP who presented with onychomadesis.ConclusionTo our knowledge, mucous membrane pemphigoid associated paronychia and onychomadesis have not been reported before. We believe it is important for dermatologists to be aware of this entity.

Nail abnormalities in subepidermal blistering diseases: a cross‐sectional study

“…10 Factors such as the duration of the disease, Figure 1 (a) Complete nail dystrophy and multiple milia in a 60-year-old man with EBA, (b) onycholysis, subungual hyperkeratosis, multiple bullae in a 75-year-old woman with BP, (c) onycholysis, subungual hyperkeratosis, multiple bullae in a 70-year-old man with BP, (d) subungual hyperkeratosis and nail plate discoloration in the left great toe and 3rd toenail of a 60-year-old man with BP, (e) multiple hemorrhagic bullous lesions in the periungual skin of a 60-year-old man with BP, (f) multiple nail dystrophy in a 50-year-old woman with EBA, (g) Beau's lines in the nails of a 47-year-old man with MMP, (h) subungual hyperkeratosis and nail scarring in a 74-year-old man with EBA, (i) onycholysis and nail discoloration in fingernails of a 53-year-old female with MMP, (j) onychomadesis in the greater toenail in a 38-year-old man with BP, (k) onycholysis, subungual hyperkeratosis, and multiple hemorrhagic blisters in a 70-year-old man with BP, (l) longitudinal melanonychia in the finger of a 60-year-old man with EBA severity, and the involved nail component can determine the extent of nail abnormality in SEABD. 10,12,16 Formerly, Habibi et al reported that nail involvement in PV has been associated with an extensive and severe form of the disease, as paronychia is a sign of exacerbation. 10,12 Previous reports on SEABD describe nail abnormalities on fingernails, 13,16,17,22,31,33 toenails, 14,20,21,29 or both.…”

“…However, depositions of IgM and C3 in BMZ of the nail bed in BP have been previously described 13 . Few cases with paronychia, nail dystrophy, nail loss, ridging, onychomadesis, pterygium, onychorrhexis, and Beau's lines have been reported as yet 10,12,14–17 . The presence of nail abnormalities may be a sign of more severe disease as suggested for other blistering diseases such as pemphigus vulgaris 10,12,15,18 .…”

“…13 Few cases with paronychia, nail dystrophy, nail loss, ridging, onychomadesis, pterygium, onychorrhexis, and Beau's lines have been reported as yet. 10,12,[14][15][16][17] The presence of nail abnormalities may be a sign of more severe disease as suggested for other blistering diseases such as pemphigus vulgaris. 10,12,15,18 The nail lesions typically disappear once the overall disease course has been controlled, but in some patients, permanent changes and scarring may occur.…”

“…10,12,15,18 The nail lesions typically disappear once the overall disease course has been controlled, but in some patients, permanent changes and scarring may occur. 15,16,[19][20][21][22] This study addresses nail involvement manifestations and their associated factors in patients with SEABD.…”

“…The presence of nail abnormalities may be a sign of more severe disease as suggested for other blistering diseases such as pemphigus vulgaris 10,12,15,18 . The nail lesions typically disappear once the overall disease course has been controlled, but in some patients, permanent changes and scarring may occur 15,16,19–22 …”