Nail dystrophy due to sarcoidosis is rare. We report a case of nail pterygium as a sign of chronic sarcoidosis in the absence of other cutaneous signs. Report of a Case A 52-year-old woman was referred to Columbia-Presbyterian Hospital, New York, because of bilateral hilar adenopathy discovered on a routine chest x-ray film. Tuberculin skin tests at 1:10,000,1:1,000, and 1:100 dilutions were negative. No skin or nail abnormalities were noted. A presumptive diagnosis of sarcoidosis (without pathologic confirmation) was made. The patient did not receive therapy. Thirteen years later, when the patient was examined in the dermatology clinic, she had a nail dystrophy of one-year duration involving the 1st, 2nd, 3rd, and 5th fingernails of the right hand and the fourth fingernail of the left hand (Fig 1). There were no other skin lesions present. There was no history of nail trauma. A combination of benzoic and salicylic acid ointment and nystatin cream were prescribed without response