Finger Nails Research Articles

A case of Buerger's disease with vasculopathy and skin fibrosis requiring differential diagnosis from systemic sclerosis.

Buerger's disease is characterized by peripheral ischemia due to occlusion of small- and medium-sized arteries in the extremities. This report describes a case of Buerger's disease in a 51-year-old male who presented with findings resembling systemic sclerosis. The patient exhibited Raynaud's phenomenon in year X-3, which developed to skin hardening, nail avulsion, and ulceration of the right fingers in year X. Diagnostic testing showed positive microvasculopathy on nailfold videocapillaroscopy (NVC) and positive fibrosis on skin biopsy. Although the patient fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for systemic sclerosis, several findings in this case were atypical for systemic sclerosis, including left-right asymmetry in finger involvement, nail loss, and negative autoantibody tests. Contrast-enhanced computed tomography showed poor perfusion of the right ulnar artery, and a heavy smoking history was established in the patient case. Therefore, based on Shionoya's criteria, he was diagnosed with a case of Buerger's disease confined to the upper extremity. Smoking cessation and vasodilator therapy resulted in the prompt resolution of ischemic symptoms, skin hardening, and ulcerations. Furthermore, NVC abnormalities improved, and ulnar artery occlusion showed reperfusion on repeat testing. The present case suggests that hypoxemia-driven microvasculopathy may contribute to vascular occlusion and skin fibrosis observed in this atypical presentation.

Structural and retrospective bio-dosimetric study of gamma-irradiated human fingernails

Emergency involving ionising radiation is a rare occurrence, yet it can leave severe damage if a population is not equipped with necessary preparation. In such a situation, there is no viable way to know how much radiation dose is received by human beings. However, in present time only personnel of rescue teams have accessed to active dosimetry such as a personal dosimeter. Preliminary study has been made of human fingernails, a model in examining the potential of nails of the human fingers in retrospective and emergency bio-dosimetry applications, also offering effective atomic number near to that of soft human tissues at 7.4. Human fingernails were sampled from different age groups and exposed to 60Co gamma rays, delivering doses from 2 to 10 Gy. Structural alterations were observed, use being made of Raman spectroscopy and the crystalline structure of alpha keratin is studied using X-ray diffraction (XRD), while the elemental composition of the sample is determined by energy dispersive x-ray (EDX) analysis. Raman shows the ‘fingerprint’ of nail sample is identical in which the peak assignment concerns on the disulfide (S–S) bond and the alpha helix content at the amide 1 region. These are the few regions which displayed major Raman shift and intensity difference from a normal nail sample and an effected nail which have the same analogy as a non-irradiated nail and an irradiated nail sample. XRD shows the molecular structure of hard α-keratin from different age groups of fingernails, examining crystallite diameters (D) and crystallinity index (C.I.). The α-keratin characteristic bands can be seen in all groups of fingernails, albeit they become much weaker and shift to smaller angles with higher gamma doses. The results obtained by Raman spectroscopy and X-ray diffraction are complementary and suggest that the α-helix structure of keratin is partially destroyed by the presence of radiation.

Surface material analysis for human papillomavirus detection in nail Bowen's disease caused by HPV type 58.

Over the past few years, cases of human papillomavirus (HPV) infection in nail Bowen's disease have been reported. This disease presents diagnostic challenges due to its similarity to nail malignant melanoma, particularly with respect to the clinical manifestation of black nail streaks. While skin biopsy is usually employed for diagnosis, it is an invasive procedure. We report the case of a 52-year-old healthy Japanese male with a pigmented streak on the nail of the fourth finger of his right hand, which had extended from the central to the lateral nail fold within 4 months. Dermoscopic examination revealed a dark-brown pigmented band with splinter microhemorrhage. Clinically, nail Bowen's disease was suspected. The lesion was excised in strips under local anesthesia. Histopathological examination revealed hyperkeratosis, parakeratosis, papillomatosis, and dyskeratotic cells with atypical nuclei irregularly arranged. Immunohistochemistry using anti-HPV L1 antibody detected HPV-positive cells in the upper epidermis and stratum corneum of the nail matrix. Mucosal high-risk HPV type 58 DNA was detected from brush cytology of the keratotic surface prior to surgery, which was confirmed in formalin-fixed, paraffin-embedded excised samples using polymerase chain reaction (PCR) and subsequent direct DNA sequencing. Our case highlights HPV type 58 as a potential causative agent of nail Bowen's disease and shows that brush cytology of the surface material prior to excision may be a useful and less invasive way for mucosal high-risk HPV detection. PCR analysis of the nail surface could serve as a supplementary diagnostic tool for nail Bowen's disease.

A novel NTRK1 splice site variant causing congenital insensitivity to pain with anhidrosis in a Chinese family.

Congenital insensitivity to pain with anhidrosis (CIPA, OMIM #256800), also known as hereditary sensory and autonomic neuropathy type Ⅳ (HSAN-IV), is a rare autosomal recessive disorder characterized by recurrent episodic fevers, anhidrosis, insensitivity to noxious stimuli, self-mutilating behavior and intellectual disability. CIPA can be caused by the variants in NTRK1 gene, which encodes a high-affinity tyrosine kinase receptor for nerve growth factor. To ascertain the hereditary cause of a patient with CIPA accompanied by the additional symptoms of mild growth retardation, prone to fracture, underdeveloped nails of fingers and toes, irregular tooth alignment, enamel hypoplasia, postoperative wound healing difficulty, hand and limb deformity, and dislocation of hip joint, whole exome sequencing was used and revealed a compound heterozygous variant in NTRK1. DNA was extracted from peripheral blood samples of pediatric patients and their parents, and subjected to comprehensive analysis using whole-exome sequencing (WES), followed by verification of variant sites in the NTRK1 gene through Sanger sequencing. To elucidate the functional impact of the newly discovered variants, an in vitro experimental system was established. Splicing analysis was conducted using PCR and Sanger sequencing, while expression levels were assessed through qPCR and Western blot techniques. One hotspot variant c.851-33T>A(ClinVar ID: 21308) and a novel variant c.850 + 5G>A(ClinVar ID:3069176) was inherited from her father and mother, respectively, identified in the affected individuals. The c.850 + 5G>A variant in NTRK1 resulted in two forms of aberrant mRNA splicing: 13bp deletion (c.838_850del13, p. Val280Ser fs180) and 25bp deletion (826_850del25, p. Val276Ser fs180) in exon 7, both leading to a translational termination at a premature stop codon and forming a C-terminal truncated protein. The expression of two abnormal splicing isoforms was decreased both in the level of mRNA and protein. In conclusion, this study elucidated the genetic cause of a patient with CIPA and identified a novel variant c.850 + 5G>A in NTRK1, which broadened the and enriched the NTRK1 mutation spectrum.

Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective cohort study

BackgroundReverse homodigital artery island flap (RHDI) has reported some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been performed to decrease these complications. This study aimed to provide a review of the CRDI procedure and to compare the clinical outcomes of CRDI with RHDI. MethodsRHDI has been performed for fingertip amputations with the deficit of 1.5–2.5cm before 2018, and CRDI has been performed since 2018. We assessed functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. ResultsWe identified 22 patients who underwent RHDI and ten patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing in RHDI was 47.0 days (IQR: 34.3–55.8), and that in CRDI was 34.5 days (IQR: 29.3–44.3). The hook nail deformity occurred significantly more frequently in RHDI compared to in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found significantly more in RHDI than in CRDI (36.4% vs. 0,0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260º–280º). The median postoperative Hand20 scores were similar between the two groups. ConclusionCRDI was associated with superior clinical outcomes in terms of lower rate of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.

Iso-Kikuchi Syndrome in A Newborn and His Mother

Iso-Kikuchi syndrome or congenital dysplasia of the index finger is a rare entity that affects primarily the nails of both index fingers, and presents with onychodysplasia or complete anonychia. The etiology remains unknown. We present two familial cases of this unusual entity.

Effect of Finger Sucking, Nail Biting, and Salivary Level of Growth Hormone on Type of Malocclusion among Primary School Students: An Analytical Cross-Sectional Study

Introduction: We aimed to assess the effect of finger-sucking, nail-biting, and salivary levels of growth hormone on the type of malocclusion among primary school students. Methods: This study was conducted among 10–11-year-old (4th and 5th class of the elementary schools) students in the center of Karbala city from February to June 2021 using a multistage cluster random sampling technique. Data related to oral habits were obtained using questionnaires, which were distributed among the students and collected the next day after being answered and signed by the parents. Unstimulated saliva samples were collected, and salivary levels of growth hormone were assessed using the enzyme-linked immunosorbent assay (ELISA) method. Data were analyzed via multinomial logistic regression using R software. Results: The finger sucking was a significant predictor for class 2 malocclusion (p < 0.001). Night-time finger sucking was a significant predictor for class 3 malocclusion (p = 0.031). Salivary levels of growth hormone and nail-biting were not significant predictors for malocclusion (p ˃ 0.05). Also, finger sucking was a marginally nonsignificant predicator for class 3 malocclusion (p = 0.057). Conclusion: Cross-sectional studies capture data at a single point in time, and they cannot establish a cause-and-effect relationship. More cohort studies are required to reach a conclusion about the effect of non-nutritive sucking habits such as finger sucking, nail-biting and salivary level of growth hormone on type of malocclusion.

Implementation of Neural Network for Classification of Diabetes Mellitus through Finger Nail Image

This study aims to obtain accuracy for classification of diabetes mellitus based on fingernail images using neural network. The data is fingernail images with fasting conditions and non-fasting conditions. In each condition, data is divided into three namely diabetes, prediabetes and normal data. Images in each data are 100 images. Methods were preprocessing, GLCM, neural network (NN) and accuracy. Preprocessing were cropping and grayscaling. GLCM were contrast, entropy, homogeneity, energy and correlation features. In NN, number of epochs used is 1000. Images in the training data is 240. The accuracy were 100% for fasting condition and 85% for non-fasting condition.

P11 A case of Mycobacterium marinum infection in a patient with rheumatoid arthritis recently initiated on adalimumab

P11 A case of <i>Mycobacterium marinum</i> infection in a patient with rheumatoid arthritis recently initiated on adalimumab

Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer.

Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer. Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V-Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick-DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two-point discrimination (2-PD) of the finger pulp was used as a measure of tactile agnosia. All donor site wounds healed well. The average follow-up time was 23.6 months (6-39 months). The mean Quick-DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2-PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour. Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger.

Novel molecular laser-induced photoluminscence signature with hyperspectral imaging for instant and remote detection of trace explosive materials

Instant detection of explosive material is highly appreciated for counterterrorism activity and homeland security. Nitro group (high energy rich bond) is responsible for explosive characteristics. Nitro group includes intense competition between two highly electronegative atoms. Nitro group is frequently encountered in all explosive materials. This function group includes delocalized π bond; that could secure intense photoluminescence (fluorescence and phosphorescence) signature. In this study, the main classes of explosive materials including nitro-compounds (i.e. TNT), nitramines (i.e. RDX), and nitric esters (i.e. PETN) were stimulated with green laser source of 532 nm and 5 mW power. The photoluminescence signature of each tested material was captured via hyperspectral camera. The tested explosives demonstrated characteristic fluorescence signature at 571, 587, and 613 nm for RDX, PETN, and TNT respectively. Furthermore, TNT demonstrated characteristic phosphorescence signature at 975 nm. The customized laser induced photoluminescence technique offered facile detection of trace explosive material via clustering approach based on K-m clustering (k = 8); this technique was able to detect RDX, PETN and TNT traces on the finger nail via processed hyperspectral images at 581 nm, 797 nm and 953 nm, respectively. This study shaded the light on novel customized photoluminescence technique for facile detection and identification of trace explosive materials.

Glomus tumor mimicking as cervical radiculopathy

Glomus tumors are rare, painful, and usually benign neoplasms typically occurring at the subungual aspect of digits. Patients usually complain of extremely painful episodes. Symptoms occur spontaneously or elicited by local compression and cold environment, in special if the tumor has an acral location. We describe a case of cervical radiculopathy caused by glomus tumor which developed spontaneously causing pain at the right index finger. Pain was excruciating, which increased on touching and sudden striking on objects. There was no neck pain, no sensory loss, and no weakness. Pain radiates to the elbow and sometimes shoulders. The patient was given trial of neuropathic medications without much relief. Nerve conduction studies were normal. Magnetic resonance imaging spine minimal disk bulge at C5–C6 level with no neural compression. On examination, the neck movements were normal and power, tone, and reflexes were normal. Neurological examination was normal. Severe tenderness on palpating the right index finger nail. MRI of the right index finger revealed a glomus tumour. Glomus tumor was diagnosed and the patient underwent surgical excision. There can be a delay in diagnosis in glomus tumours.Cervical radiculopathy may be diagnosed erroneously in patients if careful physical examination and investigations are not done.

Current status and research progress of nanoparticle application in superficial fungal infection.

Superficial fungal infections (SFIs) are characterized by diverse etiologies, complex pathogenesis, and marked geographical differences in patient symptoms. Conventional management of SFIs is associated with complications such as hepatotoxicity, skin problems, severe headaches, and clinical difficulties including intractable relapses and drug-drug interactions in patients with chronic diseases remain to be addressed. Moreover, in topical treatment, low penetration of antifungal drugs in hard tissues such as finger (toe) nails and drug-resistant fungi are emerging concerns in current antifungal therapy. Nanotechnology has been a leading research topic in recent years for new dosing forms of antifungal drugs, chemical modification of traditional drugs, and pharmacokinetic improvement, providing potential opportunities for the effective treatment of SFIs. The present study reviewed the direct use of nanoparticles in SFIs and the use of nanoparticles as carriers in SFIs and discussed their future medicinal applications.https://www.europeanreview.org/wp/wp-content/uploads/01-12915-PM-29863.jpg.

Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap Using Nail Bed Graft for Fingertip Amputation with Replantation.

Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF. Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa subzone II or III) at the authors' hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test, Fingertip Injuries Outcome Score, and Hand20 score. Overall, in 74 analyzed cases (40 replantation, 34 DAF), the median operative time and the median length of hospital stay were longer with replantation than with DAF (188 versus 126 minutes; P < 0.01; 15 versus 4 days; P < 0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening with replantation was significantly lower than with DAF (42.5% versus 82.4%; P < 0.01). There were fewer nail deformities with replantation than with DAF (45.0% versus 67.6%; P = 0.06). The proportion of patients who achieved excellent or good Fingertip Injuries Outcome Score and median Hand20 score were not significantly different between the groups (89.5% versus 85.3%, P = 0.61; 8.0 versus 13.5, P = 0.42, respectively). Median postoperative Semmes-Weinstein monofilament test values were similar between the groups (3.61 versus 3.61; P = 0.23). In this retrospective study, compared with replantation, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stays, but resulted in inferior cosmetic outcomes. Therapeutic, III.

Appearance Outcomes of Repositioned Native Nail Plate as a Free Graft and Artificial Nail Plate in the Reconstruction of the Fingertip Injuries

The aim of this study was to evaluate the cosmetic outcomes of native nail plate (NP) replacement as a free graft and using an artificial NP in reconstruction of the fingertip injuries. Two prospective cohorts of patients with fingertip injuries and avulsed NPs were evaluated. In group 1 (54 patients with 61 fingertip injuries), the native NP was available and suitable for placement under the proximal nail fold. In group 2 (31 patients with 32 fingertip injuries), the native NP was either lost or highly damaged and it was not suitable for use. In this group, an artificial NP was used. The final cosmetic outcomes of regrown NPs were evaluated at a minimum of 4 months after surgery using the Oxford Finger Nail Appearance Score. "Trapped in a door" was the most common cause of injury in pediatric patients, whereas work-related injuries were the most common cause of injury in adults. The difference between the mean appearance scores of the two groups favored group 1 (native NP). There was a negative correlation between the patient age and appearance scores, irrespective of the treatment group. The presence of a distal phalanx fracture adversely affected the appearance scores. Replacing the native NP for splinting in fingertip injuries is advantageous. Fingertip injuries in pediatric patients and fingertip injuries without distal phalanx fractures achieved better cosmesis scores. Therapeutic III.

Antibacterial activity of chloroxylenol and thymol against pathogenic bacteria isolated from under long nails.

Fingernails are a perfect area for harboring bacteria such as Staphylococcus aureus, Salmonella sp., Shigella sp., and Escherichia coli. These bacteria under the long nails may cause diseases due to the contact of nails with food or while biting the nails. Our study aimed to compare the antibacterial activity of chloroxylenol and thymol, two different detergent ingredients, on microorganisms isolated from long fingernails. This study was performed to raise awareness of the dangers of long nails and the importance of good nail hygiene. The present study was performed on female students at the Faculty of Science, King Abdelaziz University. Bacteria were isolated from under one finger nails and cultured on both McConkey agar and mannitol salt agar. After incubation, we isolated bacteria on nutrient agar. After that, we conducted several tests to determine the isolate type. Finally, we prepared three different concentrations of chloroxylenol and thymol to compare their effect on the isolated bacteria using antibacterial activity on Mueller-Hinton agar. Two types of bacteria were isolated, pathogenic bacteria called Staphylococcus aureus and non-pathogenic bacteria called Staphylococcus epidermidis. Staphylococci have more sensitivity to chloroxylenol than thymol. In addition, chloroxylenol, at high concentrations had a more powerful antibacterial effect. The results emphasized that fingernails could harbor pathogenic bacteria which are difficult to remove. Perfect hand hygiene is essential to prevent the spread of diseases.

Change of the polarization properties of the human dermis with directions of incident and observation

In this work, a simplified cylinder-birefringence optical model of the human skin dermis model is reported. The actual polarization parameters of human fingernail skin were measured. And the accuracy and stability of the Mueller matrix polarization decomposition (MMPD) and the direct Mueller matrix (DMM) methods were compared under different incident and scattering angles. One main novelty of the present work is that the value of birefringence of the skin dermis was obtained from images of living human index finger nails by using a polarization-sensitive optical coherence tomography device. The results obtained in this work provide a basis for the selection of incident and scattering angles when measuring biological samples containing fibrous structures in the future.

Ingrown Finger Nail-A Lesser Known Entity.

Dear Editor, Ingrown toenails are a common problem encountered in dermatology practice. They are caused by three major factors—excessive transverse curvature of the nail plate, maceration of the gutter and external pressure over the toe nail. In addition, the hard hyperkeratotic transversely over-curved nail plate exerts pressure and its spicule causes penetrative injury to the nail gutter under the influence of external pressure caused by running, tight fitting shoes, standing on toes etc., making the condition worsen.[1] All these factors make toes more vulnerable to having ingrown nails as compared to fingers nails. However, we have been seen few cases of ingrown fingernails in our dermatology out patient department.[2] There is a lack of scientific data on the incidence of ingrown nails on fingers. As per a recent report, finger ingrown nails were more commonly found in patients receiving epidermal growth factor receptor inhibitors (which leads to epidermolysis and easy maceration of the nail gutter).[3,4] In addition, there are some others drugs which may cause paronychia, excessive nail fold granulation tissue (pseudopyogenic granuloma)and eventually ingrown nail development, for example, cyclosporine, docetaxel, doxorubin, oral antifungals, lamivudine, indinavir, ritonavir, azidothymidine, vandetanib, capecitabine, cetuximab, giftinib, and retinoids. The main predisposing causes of ingrown finger nails may be occupation related, such as external pressure of the nail plate on its gutter during writing with the middle and ring finger, stitching, sewing, opening and shutting sliding windows, typing, vegetable cutting etc. It has been observed that ingrown finger nails are more common in the ring and middle fingers than in the index finger, which may be due to the fact that the ring and middle finger nails are more curved as compared to the index finger. Many patients diagnosed with finger nail paronychia on the distal lateral end may have ingrown nails, which might have been overlooked in the initial stage [Figure 1]. So, a careful examination of the finger nail is a must in all cases of distal end paronychia of the finger nail [Figure 2]. A change in the way fingers are used and avoiding repeated trauma in day-to-day activities are necessary for remission in such cases.Figure 1:: Ingrown finger nail in the initial stage is cut and removed from the gutterFigure 2:: Ingrown finger nail with pseudopyogenic granulomaAcknowledgment None. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial.

Surgery for nail bed injuries in children is common. One of the key surgical decisions is whether to replace the nail plate following nail bed repair. The aim of this RCT was to assess the clinical effectiveness and cost-effectiveness of nail bed repair with fingernail replacement/substitution compared with repair without fingernail replacement. A two-arm 1 : 1 parallel-group open multicentre superiority RCT was performed across 20 secondary-care hospitals in the UK. The co-primary outcomes were surgical-site infection at around 7 days after surgery and cosmetic appearance summary score at a minimum of 4 months. Some 451 children presenting with a suspected nail bed injury were recruited between July 2018 and July 2019; 224 were allocated to the nail-discarded arm, and 227 to the nail-replaced arm. There was no difference in the number of surgical-site infections at around 7 days between the two interventions or in cosmetic appearance. The mean total healthcare cost over the 4 months after surgery was €84 (95 per cent c.i. 34 to 140) lower for the nail-discarded arm than the nail-replaced arm (P < 0.001). After nail bed repair, discarding the fingernail was associated with similar rates of infection and cosmesis ratings as replacement of the finger nail, but was cost saving. Registration number: ISRCTN44551796 (http://www.controlled-trials.com).

A case of extensive verrucosis in 45-year-old women and CD4 lymphopenia treated with electrodessication using general anesthesia and isoprinosine

The human papilloma virus (HPV) is a viral infection that has a broad variety of clinical manifestation. The clinical manifestation really depends on the type of HPV virus and the immunity status of the host, particularly the cell-mediated immunity. Extensive verrucosis is one of the significant clinical manifestation of a disseminated HPV infection that is related with a severe immunodeficiency status. Electrodessication or laser surgery is a method of treatment that could directly destroy the lesion in one time. We described a case of a 45 years-old woman with extensive verrucosis. The patient complained multiple warts lesion on the hands, face, neck, lower arms and lower extremities since eight years ago. Physical examination revealed on the dorsum and palmar hands, both of finger nails (I, II, III, and IV), face (forehead and cheeks), anterior of neck, lower arms and 2/3 distal of lower extremities part anterior, there were single and groups of flesh coloured papules and flesh coloured plaques, skin colour papules with flat topped, greyish papules and greyish plaques with verrucous surfaces and brownish crusts. The CD4 count of the patient was 91 cells/µL. Skin biopsy and histopathology examinations showed hyperkeratosis, papillomatosis, and acanthosis with vacuole cell (koilocytes). The patient was treated with electrodessication using general anaesthesia and isoprinosine 3x500 mg. The result after two weeks post-treatment showed that there were no new lesions appeared on post electro surgery site. This case highlights the importance of the treatment for the success of extensive verrucosis with CD4 lymphopenia.