Abstract
The Cutting Edge: Challenges in Medical and Surgical Therapeutics <h3>REPORT OF A CASE</h3> An 18-year-old Hispanic woman presented with a slowly progressive and cosmetically disfiguring dystrophy of her fingernails that began at 4 years of age and that recently began to involve her toenails. Her medical history was significant for several episodes of oral candidiasis, hypoparathyroidism, adrenocortical failure (Addison's disease), and ovarian failure. She was receiving replacement therapy with hydrocortisone, fludrocortisone acetate, estrogen, calcium, and vitamin D for her endocrinopathies. There was no family history of skin, hair, or nail disease or endocrinopathy. The findings from her physical examination revealed severely dystrophic fingernails with some proximal nail fold hyperpigmentation (<b>Figure 1</b>). Also noted was dystrophy of the left great toenail and early involvement of the left second toenail. Patchy hyperpigmentation of the buccal mucosa and hard palate with superficial whitish plaques were observed (<b>Figure 2</b>). The dentition appeared normal. Cultures
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