Nail lesions

A 28-year-old male patient was referred to our dermatology outpatient clinic for evaluation of nail lesions. He had growths at the proximal nail fold of several of his toes that were present for 2 years. Prior treatment with miconazole cream was unsuccessful in clearing the nail lesions. His medical history was significant for asthma, for which he used salbutamol and salmeterol/fluticasone inhalation. Furthermore, at the age of 1 year he was diagnosed with epilepsy. There was no family history of dermatological or genetic disorders.

At clinical examination, multiple, pink-coloured pedunculated papules at the lateral basis of the proximal nail fold of digit 1 and 4 of his left foot were noted (Figure 1). Further, total body skin inspection revealed multiple hypo-pigmentated maculae at the trunk and a slightly elevated skin-coloured plaque at the lower back. At the malar region of the face, several red papules were seen.

Histopathological analysis of a skin biopsy obtained from a papule at the proximal nail fold showed hyperkeratosis of the epidermis and thick collagen bundles together with dilated vessels in the dermis. Histopathological analysis of a skin biopsy of the plaque at the lower trunk showed thickened bundles of collagen within the dermis with widely spaced, diminished, and fragmented elastic fibres, consistent with a collagenoma.