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Multiple calcified subungual epidermoid inclusions.
J Am Acad Dermatol 2007; 56(2):336-9JA

Abstract

Subungual epidermoid inclusions (also known as subungual onycholemmal cysts) are an uncommon and distinctive nail abnormality occurring in the dermis of the nail bed. Clinically the nail plate may exhibit onychodystrophy, clubbing, ridging, thickening, pigmentation, or appear normal. We report the case of a patient with onychodystrophy of the right halux of 7 years' duration. This case is presented with serial pictures demonstrating the gradual development of nail plate thickening, yellow discoloration, and nail bed hyperkeratosis indicative of the disease. She had negative fungal cultures, poor response to topical and oral antifungal agents, and an initial nondiagnostic superficial biopsy. Repeat full-thickness nail bed biopsy results revealed multiple calcified subungual epidermoid inclusions epidermoid inclusions. Histologic features included characteristic elongation of the rete ridges with cyst formation and pinching off of the connection to the nail bed epithelium, forming free-lying cysts within the dermis of the nail bed. The cysts contained compact onycholemmal keratin and calcification. A granular layer was not present. This case reinforces the need to clinically reassess, possibly x-ray, and perform a sufficient biopsy for persistent undiagnosed nail unit disorders. Subungual calcified inclusions may be an underrecognized and more common entity than currently recognized.

Authors+Show Affiliations

Department of Dermatology, Brown Medical School, Providence, RI 02903, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17097384

Citation

Telang, Gladys H., and Nathaniel Jellinek. "Multiple Calcified Subungual Epidermoid Inclusions." Journal of the American Academy of Dermatology, vol. 56, no. 2, 2007, pp. 336-9.
Telang GH, Jellinek N. Multiple calcified subungual epidermoid inclusions. J Am Acad Dermatol. 2007;56(2):336-9.
Telang, G. H., & Jellinek, N. (2007). Multiple calcified subungual epidermoid inclusions. Journal of the American Academy of Dermatology, 56(2), pp. 336-9.
Telang GH, Jellinek N. Multiple Calcified Subungual Epidermoid Inclusions. J Am Acad Dermatol. 2007;56(2):336-9. PubMed PMID: 17097384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple calcified subungual epidermoid inclusions. AU - Telang,Gladys H, AU - Jellinek,Nathaniel, Y1 - 2006/10/10/ PY - 2006/07/06/received PY - 2006/07/06/revised PY - 2006/08/05/accepted PY - 2006/11/14/pubmed PY - 2007/2/7/medline PY - 2006/11/14/entrez SP - 336 EP - 9 JF - Journal of the American Academy of Dermatology JO - J. Am. Acad. Dermatol. VL - 56 IS - 2 N2 - Subungual epidermoid inclusions (also known as subungual onycholemmal cysts) are an uncommon and distinctive nail abnormality occurring in the dermis of the nail bed. Clinically the nail plate may exhibit onychodystrophy, clubbing, ridging, thickening, pigmentation, or appear normal. We report the case of a patient with onychodystrophy of the right halux of 7 years' duration. This case is presented with serial pictures demonstrating the gradual development of nail plate thickening, yellow discoloration, and nail bed hyperkeratosis indicative of the disease. She had negative fungal cultures, poor response to topical and oral antifungal agents, and an initial nondiagnostic superficial biopsy. Repeat full-thickness nail bed biopsy results revealed multiple calcified subungual epidermoid inclusions epidermoid inclusions. Histologic features included characteristic elongation of the rete ridges with cyst formation and pinching off of the connection to the nail bed epithelium, forming free-lying cysts within the dermis of the nail bed. The cysts contained compact onycholemmal keratin and calcification. A granular layer was not present. This case reinforces the need to clinically reassess, possibly x-ray, and perform a sufficient biopsy for persistent undiagnosed nail unit disorders. Subungual calcified inclusions may be an underrecognized and more common entity than currently recognized. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/17097384/Multiple_calcified_subungual_epidermoid_inclusions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(06)02241-9 DB - PRIME DP - Unbound Medicine ER -