Nail Bed Involvement in Pemphigus Vulgaris

An unusual case of pemphigus vulgaris presenting as bilateral foot ulcers

“… 6 Other uncommon manifestations of pemphigus vulgaris include paronychia, 7 trachyonychia, 8 and nail bed erosion. 9 To the best of our knowledge, this is the first reported case of pemphigus vulgaris presenting with bilateral foot ulcers.…”

Nail findings in pemphigus vulgaris

“…Recovery is usually complete, leaving no permanent disfigurement, 6,14 although Baumal et al . reports permanent loss of the right great toe nail following a chronic erosion of the nail bed 10 . While we did not use intralesional triamcinolone in our patient, it should be of benefit theoretically, as this strategy has reportedly worked for other diseases affecting the nails, including alopecia areata, lichen planus, and psoriasis 16–19 …”

“…The most common nail manifestations found in PV are chronic paronychia and onychomadesis 4–9 . Other reported changes include nail‐plate discoloration, trachyonychia, onychorrhexis, onycholysis, Beau's lines, subungual hemorrhage and subungual hyperkeratosis 3,4,6–13 . Such lesions can occur as the initial presentation of PV, 5,6,8,12,13 during a flare of the disease, 7,11,13 or between disease exacerbations 6,910,13 .…”

“…reported success with a combination of prednisolone 40 mg daily with the application of a potent topical steroid 12 . Other successful systemic therapies previously reported consist of prednisolone, 9,10,12–14 prednisone, 5,8,15 azathioprine, 8,13,14 cyclophosphamide, 6,15 cyclosporinee A, 8,13 antibiotics, 6,13 plasmapheresis, 14 and IVIG 6 . Recovery is usually complete, leaving no permanent disfigurement, 6,14 although Baumal et al .…”

Recurrent Paronychia as a Presenting Manifestation of Pemphigus Vulgaris: A Case Report

“…It manifests as chronic paronychia, onychomadesis, Beau's lines, trachyonychia, onycholysis, subungual hemorrhage, nail plate discoloration, pitting, onychoschizia, and nail dystrophy [6,7,8,9,10,11,12,13,14,15,16,17,18,19]. Pseudopyogenic granuloma of the proximal or lateral nail fold can also be seen, and it has been reported to be the first symptom of a relapse of the disease [20].…”