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10-Year History of Pitted Nails


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Am Fam Physician. 2015 Oct 1;92(7):627-628.

A 30-year-old white man reported a 10-year history of itchy, scaly fingernails that chipped and fell off easily. The nails were pitted but not painful. All of his fingernails, but none of his toenails, were affected. He also had patches of dry, scaly skin on his scalp, low back, and genitals. He was otherwise healthy. He had been employed as a handyman. His family history was unremarkable.

On physical examination, most of the nails were intact but had some proximal erosion. The distal nails were clipped close, but some had separation from the nail bed, with scaling and yellowing distally. Most of the nails displayed pitting, with the periungual area unaffected (Figure 1). The patient had one pink patch with scale on the right temporal scalp, and additional patches on his back and scrotum.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Alopecia areata.

B. Chronic paronychia.

C. Iron deficiency.

D. Psoriasis.

E. Sarcoidosis.

Address correspondence to Vikram Raj Jörgen Butani, MD, at Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.


show all references

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5. Van den Bosch F, Manger B, Goupille P, et al. Effectiveness of adalimumab in treating patients with active psoriatic arthritis and predictors of good clinical responses for arthritis, skin and nail lesions. Ann Rheum Dis. 2010;69(2):394–399.

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7. Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. 2008;77(3):339–346.

8. Killip S, Bennett JM, Chambers MD. Iron deficiency anemia [published correction appears in Am Fam Physician. 2008;78 (8):914]. Am Fam Physician. 2007;75(5):671–678.

9. Wu JJ, Schiff KR. Sarcoidosis. Am Fam Physician. 2004;70(2):312–322.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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