The Nail Fold in Pemphigus Vulgaris

Abstract

To the Editor.— Involvement of the nail unit in pemphigus vulgaris is uncommon, and not well described in standard textbooks. 1 We describe a patient with generalized pemphigus vulgaris and serosanguineous fluid and crusts at the proximal and lateral nail folds. This fluid and crust were the sole clinical manifestation of pemphigus vulgaris of the nail folds. This finding has not previously been reported. Report of a Case.— A previously healthy 41-year-old man presented to the Mount Sinai Medical Center with a 6-month history of recurrent erosions in the mouth, and on the back, face, and chest. A skin biopsy and direct and indirect immunofluorescence confirmed the diagnosis of pemphigus vulgaris. Treatment with 160 mg/d of prednisone and 150 mg/d of cyclophosphamide was begun, and there was gradual improvement over the next few weeks. The nail plates showed onychoschizia; the lateral and proximal nail folds of all 10 fingernails were