Isolated painful onycholysis in a 40-year-old woman with Crohn's disease

摘要

A 40-year-old woman with a history of well-controlled Crohn's disease and a nonspecific arthritis presented with painful onycholysis of numerous fingernails and toenails for the past year. Symptoms began while gardening, when tender red macules developed on her nails that gradually extended and caused separation of the nail plate. Prolonged exercise in tight shoes seemed to initiate the same symptoms and signs on her toenails. She denied photosen-sitivity or skin eruptions. Her medications included drospirenone and ethinyl estradiol, mesalamine, hydroxy-chloroquine, and folic acid. Physical examination revealed onycholysis of her fingernails and toenails and reddish discoloration of several nail beds (Fig. 1). There were no bullae or hypertrichosis. Initial impression was that of photo-onycholysis from the oral contraceptive, but this medication was stopped without improvement. She was asked to return to clinic during a painful episode, and a biopsy of the nail bed was obtained at that time.