image

Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Report
Case Report
Editorial
Focus
Images/Instrument in Dermatology/Dermatosurgery
Innovations
Letter to the Editor
Living Legends
Looking back in history
Original Article
Perspective
Resident Forum
Residents Forum
Review Article
Spot the Diagnosis
Tropical Dermatology
Visual Treats in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Report
Case Report
Editorial
Focus
Images/Instrument in Dermatology/Dermatosurgery
Innovations
Letter to the Editor
Living Legends
Looking back in history
Original Article
Perspective
Resident Forum
Residents Forum
Review Article
Spot the Diagnosis
Tropical Dermatology
Visual Treats in Dermatology
View/Download PDF
image

Translate this page into:

Visual Treats in Dermatology
2022
:2;
105
doi:
10.25259/CSDM_108_2022

Onychomadesis: A marker of disease activity in bullous pemphigoid?

Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Corresponding author: Arunachalam Narayanan, Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. narayanan359@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Narayanan A. Onychomadesis: A marker of disease activity in bullous pemphigoid? CosmoDerma 2022;2:105.

A 65-year-old male patient, a known case of bullous pemphigoid, presented with multiple tense, fluid-filled bullae over the trunk, and extremities for the past 7 months. He had onychomadesis of all fingernails on the right hand, left index fingernail, and left ring fingernail [Figure 1a and b]. The patient had periungual disease activity on most nails with onychomadesis. The diagnosis of bullous pemphigoid had been made earlier based on histopathology and direct immunofluorescence. However, he was not on regular treatment. We made a final diagnosis of bullous pemphigoid with onychomadesis and started him on prednisolone 0.5 mg/kg/day with good improvement. Onychomadesis is the separation of the proximal nail plate from the nail matrix and nail bed. The proximal nail fold, nail matrix, nail bed, and hyponychium express the target antigens of bullous pemphigoid.[1] In addition, IgG and C3 deposition have been noted in the basal membrane zone of the nail bed of patients with bullous pemphigoid.[2] The prolonged inflammation of the nail matrix and periungual bullae might be implicated in the development of onychomadesis. Onychomadesis may also point toward disease activity in patients with bullous pemphigoid.

Figure 1:: (a and b) Onychomadesis of all fingernails on the right hand, left index fingernail, and left ring fingernail with periungual inflammation.

Declaration of patient consent

Patient’s consent not required as patient’s identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , . The basement membrane zone of the nail. Br J Dermatol. 1994;131:499-505.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . Immunofluorescence of the nail bed in pemphigoid. Am J Dermatopathol. 1987;9:349-50.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
685

PDF downloads
6
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections