Toe Nails Research Articles

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.

Serum zinc levels and body composition variability as trajectory for hyperlipidemic and dyslipidemic effect among welders exposed to welding fumes and smoking: A biomarker for cardiovascular health

Welding is a common method for joining metals by heating them to the welding temperature. Exposure to welding fumes has a serious effect on the health of welders. This study examined serum zinc variability and body composition as route for hyperlipidemia and dyslipidemia in welders exposed to welding fumes and smoking, exploring the possibilities for the risk of possible cardiovascular disease. The experimental case control design was adopted in the study. Forty apparently healthy adult males were randomly selected comprising of twenty control group (non-smokers and smokers without welding experience) and twenty experimental group (non-smokers and smokers with welding experience) welders. Data obtained were represented as Mean ± SEM while comparison of means across group was done by one-way ANOVA followed by Tukey's multiple comparison for post hoc test at p-value < 0.05 level of significance using Graph Pad prism version 8. The data obtained showed that the body mass index (BMI) of smokers (non-welders and welders) were slightly reduced while that of non-smoking welders was increased compared to the control. The serum zinc level increased among the smoking welders, while the smoking non-welders and non-smoking welders decreased when compared to the control group (p < 0.05). Exposure to welding fumes has been shown to increase total cholesterol levels compared to the control. Weld fumes significantly (p < 0.05) increased high-density lipoproteins (HDL) levels among smoking non-welders compared to the control group, while, HDL was reduced in non-smoking welders and smoking welders, respectively (p < 0.05). Triglyceride levels significantly (p < 0.05) increased in all experimental groups compared to control levels (p < 0.05). Exposure to welding fumes and smoking caused significant changes in serum zinc, HDL and triglycerides levels with implications for the formation of plaques around the arteries interfering with the effective flow of blood through the vascular system, with implications of hyperlipidemia and dyslipidemia. This study recommends that further studies should be done using biomarkers from urine or toe nails.

The difference of fungal growth Rhizopus sp. in SDA and PDA Media from toe nail samples of construction workers

Onychomycosis is a fungal infection caused by dermatophyta and non-dermatophyte groups which infect the toenails or fingernails. Onychomycosis infection can lead to the damage of the nails which causes the nail thickness, brittle, and easily destroyed. Rhizopus sp. is considered to be one of the fungal species in the non-dermatophyte fungal infection group in the disease Onychomycosis. This study aims to determine the differences in the growth of non-dermatophyte fungi that cause onychomycosis infections on SDA and PDA media in samples of toenails from construction workers in Lamongan Regency. The research method used is descriptive, and the sampling technique used is random sampling. The sample size examined was 15 construction workers in duplicate, 15 planted in PDA media and 15 planted in SDA media. The material for this examination is scrapings from the toenails of construction workers which are planted directly on SDA and PDA media, then followed by macroscopic and microscopic examination. Based on macroscopsic examination, it was found that the colonies were white to grayish white, had a cotton-like surface and were spreading. Based on microscopic examination using the addition of 1 drop of LCB dye reagent, fungal elements were obtained which indicated the non-dermatophyte fungus Rhizopus sp. namely there are stolon, rhizoid, sporangiospore, sporangium and apoplysis. From the results of this research it can be concluded that there is growth of the fungus Rhizopus sp. non-dermatophyte group on PDA media and SDA media, there was no difference in the growth of non-dermatophyte fungi that cause onychomycosis in the toenails of construction workers in Lamongan Regency on PDA media and SDA media and there was a difference in the growth of the fungus Rhizopus sp. Non-dermatophyte groups causing onychomycosis based on age.

Topical Antifungal Therapy Combined with Nail Abrasion for the Treatment of Dermatophytoma: Single-Center Results — A Secondary Publication

Objective: Recently, topical antifungal agents have become available for the treatment of dermatophytoma. However, there are few reports of topical onychomycotic agents in combination with debridement of dermatophytoma. Methods: Twelve patients with dermatophytoma diagnosed and treated between April 2017 and March 2020 at the Department of Dermatology, Kansai Rosai Hospital were selected, including two patients with lesions on both toe nails and 14 nails. At the initial visit, the affected nail plate was removed and topical treatment was administered. The observation was terminated when the lesions were completely healed within 1 year. If the patients were not completely healed, the initial efficacy was determined at the date of the first visit closest to 1 year after the start of treatment. The second efficacy evaluation was conducted at the last visit or when the concomitant drug was changed. Results: Three patients dropped out of the study before the time of the initial efficacy evaluation. In the second efficacy evaluation, eight nails were completely healed, one nail was significantly healed, and one nail was effective. Conclusions: Dermatophytoma can be treated with topical onychomycotic agents in combination with surgical debridement to improve efficacy.

Differential Diagnosis of Retronychia, Onychomycosis and Onychomadesis.

In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts. We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient's complaint was solved after around one year without any specific therapy. The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments. The differential diagnosis of retronychia, onychomycosis and onychomadesis is challenging.Both onychomadesis and retronychia share a common pathophysiologic mechanism.A careful and detailed history prevents a patient from a frightening diagnosis and painful, long-lasting treatment of nail disorders.

Treatment of ingrown toe nail by homoeopathic approach

Treatment of ingrown toe nail by homoeopathic approach

Epidermolysis bullosa: a tale of two sisters

Epidermolysis bullosa (EB) is a clinically and genetically heterogenous, inherited, mechanobullous disorder characterised by spontaneous or trauma induced blisters over skin and mucous membranes. Four major forms are: EB Simplex, EB Junctional, EB dystrophic and mixed. A 11-year-old and a 9 year old female child, both sisters, accompanied by their father, presented to dermatology OPD, with chief complaints of multiple raw areas over elbows and knees since infancy. There was history of fluid filled lesions which were induced by trauma or friction during handling or while playing. These lesions ruptured on their own or on trauma to form raw areas with crusting which further healed with scarring and small white raised lesions. Also, he gave history of loss of nails following blistering on toes in infancy. No associated systemic complaints were noted. On examination, both of them presented with multiple erosions and ulcers with oozing of blood, few bullae and crusted lesions over elbows, knees and feet. There were multiple atrophic scars and skin coloured to whitish papules [milia] over feet, ankles, elbows and knees. There were loss of nails of toes of both feet. On biopsy, histopathological examination revealed bullae at dermoepidermal junction. Diagnosis of EB junctional was made. EB is a rare inherited disorder. Its management includes prevention and healing of blisters and infection. Psychological support to patients and their families is of prime importance.

BH08 A clinical case of retronychia, a rarely described post-traumatic proximal ingrown nailplate: a condition of the ‘nail’

Abstract Retronychia is a recently described inflammatory disorder that leads to proximal ingrowth of the nail and paronychia. There are fewer than 100 published cases of retronychia, leading to a poor understanding of the disorder and a delay in diagnosis and treatment. Increased understanding for clinicians will be critical in avoiding misdiagnosis and effective management (Costa TPE. Retronychia: a paradigm shift? Skin Appendage Disord 2020; 6:268–71). A 36-year-old woman presented to dermatology with a near three-decade history of treatment-resistant painful, thickened yellow nails of both greater toes. Past medical history included bilateral bunions since the age of 14 years, which were surgically corrected. In the community, she had undergone partial nail avulsion by chiropodists. Subsequently, she received multiple courses of antifungal lacquer and oral terbinafine, all with no effect, and continued regrowth of abnormal thickened nails. On examination of her greater toes, the proximal nailfolds lacked cuticles. The nails showed horizontal ridges, were thickened by stacking of nailplates and had a yellow discoloration. Investigations for fungal nail were negative. A clinical diagnosis of retronychia was made. Retronychia was first recognized in 1999 and is a combination of nailplate ingrowth into the proximal nailfold and the generation of multiple misaligned proximal nailplate lamellae. It is more common in women, typically affects the great toes and is triggered by repetitive microtrauma related to sports, inadequate footwear or, in this case, bunions (de Berker D, Richert B, Duchard E et al. Retronychia: proximal ingrowing of the nail plate. J Am Acad Dermatol 2008; 58:978–83). As in this case, most patients are inadequately treated with antifungals and antibiotics, perhaps due to signs of paronychia resulting in treatment failure and significant psychological impact. If cases are recognized early, conservative management with topical steroids applied to the proximal nailfold is effective. In advance cases, as with this patient, surgical nailplate avulsion with nail matrix ablation is the only curative management. Awareness of the clinical signs would be a valuable learning point for clinicians.

AFATINIB-RELATED ORAL ULCERATION

Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement. Treatment of malignant neoplasms with antibodies is associated with oral mucosal side-effects. Afitinib may cause mucocutaneous lesions that mimic ordinary oral ulceration due to the blockage of the epidermal growth factor. This report aimed to describe a case of mucocutanous lesions associated with Afatinib. A 63-year-old Caucasian female, diagnosed with non-small cell lung carcinoma, presented painful, recurrent oral ulcerations since starting treatment for her lung disease. Upon intraoral examination, irregular 3 to 6-mm ulcers surrounded by an erythematous halo were detected in her lower labial mucosa, hard palate, and lingual frenulum. Upon extra-oral examination, ulcerative lesions were also detected on both the right and left aspects of her hallux (big toe) nail. The patient was treated with low-level laser therapy with marked clinical and symptomatic improvement.

Hoof Expansion, Deformation, and Surface Strains Vary with Horseshoe Nail Positions.

Racehorses are susceptible to underrun heel hoof conformation. Racehorses are often shod with nails placed toward the heel. It is unknown if palmar nails restrict or alter hoof deformation in a manner that could promote the development of underrun heel conformation over time with repeated loading. To determine how the addition of palmar nails affects heel deformation during limb loading, hoof expansion and hoof wall deformations were quantified using rosette strain gauges and kinematic markers during in the vitro limb loading of cadaveric limbs that simulated midstance for walk, trot, and canter loads. Nail treatments used to attach a horseshoe to the hoof included: toe nails (T), toe and quarter nails (TQ), and toe, quarter, and heel nails (TQH). The effects of nail treatment on heel expansion and hoof wall deformations were assessed using repeated measures analysis of variance (p < 0.05). Nails placed palmar to the quarters of the hoof decreased heel expansion (p < 0.001). Heel nails resulted in the largest changes in hoof wall principal strain directions distally. The application of nails palmar to the hoof quarters alters hoof wall deformation during limb loading. The continued loading of the hoof with palmer nails could alter hoof conformation over time.

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.

Vesiculo-bullous Darier disease late onset in association with polycythemia vera

Vesiculo-bullous lesions as well as the late onset are extremely rare features of Darier disease (DD) making positive diagnosis more difficult. Its association with polycythemia vera prompts to look for signs suggestive of malignant hematological transformation. We report a case of a 62-year-old patient, followed in internal medicine since the age of 58 for polycythemia vera. She presented for pruriginous vesiculo-bullous dermatosis evolving for 4 years. On clinical examination, papulo-vesicular plaques were found involving all the folds: inguinal, axillary, inter-gluteal, neck and body with palmo-plantar blisters and pustules. Examination of the toe nails showed alternating red and white longitudinal bands. Abdominal examination showed moderate splenomegaly. Skin biopsy revealed focal acantholysis with supra-basal clefts, dyskeratosis with the presence of round bodies and grains compatible with Darier's disease. A paraneoplastic assessment was made including a thoraco-abdomino-pelvic CT scan, a breast ultrasound and mammography with cervico-vaginal smear, a CT scan of the cavum and a pancreatic MRI, which did not show any progressive malignant process. The patient was put on oral retinoids at a rate of 0.5 mg/kg per day and topical calcipotriol associated with bloodletting to reduce the hematocrit level. The evolution was marked by clinical improvement. The patient was followed in the hematology department and showed no acute leukemia or myelofibrosis or other neoplasms after a 2-year follow-up. We report a case of late DD in a woman followed for polycythemia vera, characterized by a rare vesiculo-bullous presentation and whose causal link remains to be determined.

DeepNAPSI multi-reader nail psoriasis prediction using deep learning

Nail psoriasis occurs in about every second psoriasis patient. Both, finger and toe nails can be affected and also severely destroyed. Furthermore, nail psoriasis is associated with a more severe course of the disease and the development of psoriatic arthritis. User independent quantification of nail psoriasis, however, is challenging due to the heterogeneous involvement of matrix and nail bed. For this purpose, the nail psoriasis severity index (NAPSI) has been developed. Experts grade pathological changes of each nail of the patient leading to a maximum score of 80 for all nails of the hands. Application in clinical practice, however, is not feasible due to the time-intensive manual grading process especially if more nails are involved. In this work we aimed to automatically quantify the modified NAPSI (mNAPSI) of patients using neuronal networks retrospectively. First, we performed photographs of the hands of patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis. In a second step, we collected and annotated the mNAPSI scores of 1154 nail photos. Followingly, we extracted each nail automatically using an automatic key-point-detection system. The agreement among the three readers with a Cronbach’s alpha of 94% was very high. With the nail images individually available, we trained a transformer-based neural network (BEiT) to predict the mNAPSI score. The network reached a good performance with an area-under-receiver-operator-curve of 88% and an area-under precision-recall-curve (PR-AUC) of 63%. We could compare the results with the human annotations and achieved a very high positive Pearson correlation of 90% by aggregating the predictions of the network on the test set to the patient-level. Lastly, we provided open access to the whole system enabling the use of the mNAPSI in clinical practice.

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.

A CASE REPORT ON A RARE DISEASE: ZINSSER-ENGMAN-COLE SYNDROME (A.K.A DYSKERATOSIS CONGENITA)

Zinsser-Engman-Cole syndrome is a rare but complex multi-system disorder. The clinical diagnosis of classical Dyskeratosis Congenita requires at least two features of the triad of dysplastic nails, lacy reticular pigmentation of the upper chest and/ or neck and oral leucoplakia. A 16-year-old boy presented to our hospital with complaints of swelling on the right side of neck and pain on swallowing solids, liquids and saliva. Leucoplakia was noted on his tongue and all of his ngers and toe nails were markedly dysplastic. His skin was spotted with reticular pigmentation on the upper trunk and back. Also, a swelling of size 6 cm in diameter was noted on the right side of his neck. FNAC was done from the right neck swelling which showed metastatic Squamous Cell Carcinoma. It was followed up with a biopsy from laryngeal wall which showed Well Differentiated Squamous Cell Carcinoma. Individuals with DC most commonly present with skin pigmentation, dystrophic nails and leucoplakia, as presented in this case. Associated epithelial malignancies are common. DC is a severe multisystem disorder associated with premature morbidity and mortality. We believe that reporting this case would add more information to the existing fund of knowledge

Work-Related Dermatoses of the Feet in Professional Dancers: A Pilot Study

The feet of professional dancers are exposed to high work-related stresses. To date, data from the professional dance sector concerning this matter are lacking. The aim of this exploratory project was to analyze and evaluate skin health in the foot area with regard to the prevalence of dermatoses, their locations, as well as gender-specific and load-specific differences. Professional classical and neo-classical ballet dancers were examined at two time points: in a phase with increased stress (T0: daily training sessions, rehearsals, and high performance frequency) (n=51, 35 females, 16 males) and after a 24-day rest phase (T1: n=35, 28 females, 7 males). In addition, gender-specific and load-specific (T0 and T1) differences were evaluated. All professional dancers were affected by skin lesions of the feet at T0. Hyperkeratosis (96.1%), onychomycosis (27.5%), and subungual hematoma (11.8%) were the most frequent dermatoses of the feet of professional dancers. Onychomycosis affected the nails of the big toes in particular (right 15.7%; left 13.7%), and subungual hematomas were found exclusively on the nails of the first toe (right 7.8%; left 7.8%). Women tended to be more frequently affected by hyperkeratosis, men more frequently by onychomycosis. There were no load-specific differences between the stress and rest phases. The prevalence of work-related dermatoses is equally high among female and male dancers. The results can be used for further research and serve as a basis for specific measures of behavioral and environmental prevention in dance.

Clinical Outcome of Wedge Resection Procedure for Ingrown Toe Nail

Aim: To evaluate the results of the wedge resection procedure in the treatment of ingrown toenails Place and duration of study: The detailed study was carried out at Shahida Islam Medical College Lodhran and Rajib Tayyip Erdogan Hospital, Muzaffargarh, between September 2020 to August 2022. Methods: We conducted a prospective study on 73 patients who underwent wedge resection procedures between Sept 2019 to August 2021. We noted the demographic details like mean age, gender distribution, postoperative complication rate, recurrence rate, and satisfaction with the procedure. Results: The mean age(SD) was 29.3 (4.7) years with 33% males and 67% females. Wefound that 6 min was the average duration of the procedure and only two patients had postoperativecomplications; 99% were satisfied with the outcome and only 1.37% showed recurrence of the issue. Conclusion: We can conclude Wedge Resection Procedure is a safe, effective, and convenient technique in the management of ingrown toe nails. Keywords: ingrown toenail, Wedge Resection Procedure (WRP)

Ibrutinib-Associated Multifocal Paronychia with Periungual Pyogenic Granulomas Involving Concomitant Finger and Toe Nails.

Ibrutinib-Associated Multifocal Paronychia with Periungual Pyogenic Granulomas Involving Concomitant Finger and Toe Nails.

Porokeratotic variant of lichen planus or lichen planus with porokeratosis: report of a challenging case

Annular lichenoid diseases have many differential diagnoses. Lichen planus (LP) and porokeratosis could show annular-shaped lesions with a lichenoid tissue pattern infiltration, but typical cornoid lamella formation is mainly in favor of porokeratosis. We present a 57-year-old man with papulovesicular and annular lesions on the shins with an exophytic lesion of left great toe nail. Papular lesions showed classic histopathology of LP, but annular lesions revealed imperfect cornoid lamella formation that could be seen in the porokeratotic variant of LP. Nail bed biopsy showed in-situ squamous cell carcinoma and so distal phalangeal amputation was performed. Our patient had no good response to topical and systemic steroid, but he had moderate improvement with oral retinoid. We think that our case had different types of LP including classic, bullous and porokeratotic variants which is a rare association.

An Interesting Case Report of Acquired Triradiate Periungual Fibrokeratoma and its Dermoscopic Features.

Dear Editor, A 6-year-old girl attended our nail OPD (Out Patient Department) for an opinion on rapidly growing two finger-like projections at the proximal nail fold of her right fourth finger for 3 months. The growth was painless and asymptomatic. There was no history of trauma or any significant systemic disease. On clinical examination, there were two finger-like projections with keratotic tips that were fused proximally at the proximal nail fold of her right fourth finger. The underlying nail plate was normal except for the depression with a concave surface underneath the tumor. There was no evidence of a shagreen patch or angiofibroma on the face. There was no history of convulsions in the past or similar family history. On dermoscopy with DermLite DL4, contact polarized view at 10× magnification, we could appreciate two filiform rod-like projections with one more projection starting to grow from the side. There were five zones in each projection. From proximal to distal the zones were a white structureless zone, a red structureless area, a structureless brown area, a well-delineated dark brown area, and a lighter overhanging rim-like brown area at the distal-most end [Figure 1].Figure 1: Filiform projections (Dermoscopic view - Dermlite DL4,10X)We made a provisional diagnosis of acquired periungual fibrokeratoma. Our differentials were supernumerary digit, acral fibromyxoma, and wart.[1] The lesion was completely excised under a digital block. The proximal nail fold was everted by giving two incisions on either side of the growth and the tumor was exposed using stay sutures on either side. We dissected the tumor from the underlying nail plate and the overlying proximal nail fold. The tumor was excised in toto and sent for histopathology. The incisions were closed with 5–0 prolene and suture removal was done on day 10. The postoperative period was uneventful with no evidence of recurrence after 6months and the patient was kept on follow-up. On histopathology, the finger-like projections [Figure 2] were seen which were lined by horny hyperkeratosis, hypergranulosis, acanthotic epidermis with the dermis showing dense collagen fibers, dilated thin-walled capillaries, and fibroblasts [Figure 3].[2]Figure 2: Finger-like projections lined by hyperkeratosis, hypergranulosis, and acanthotic epidermis (H & E, 4×)Figure 3: The dermis with dense collagen fibers, dilated thin capillaries, and fibroblasts (H & E, 40×)The dermoscopic and histopathological correlation of this case is as follows [Table 1].Table 1: Dermoscopic and Histopathologic correlationBased on the clinical, dermoscopic, and histopathological correlation, the diagnosis of Type 2 acquired periungual fibrokeratoma (AUFK) was made. AUFK are benign fibrokeratotic tumors.[3]The classical presentation of AUFK is an asymptomatic single-skin colored nodule with a hyperkeratotic tip emerging from the proximal nail fold or directly from the nail bed. The pathogenesis is not yet validated; however, the role of trauma, presence of factor XIIIa positive dermal dendrocytes, preceding streptococcal infection, and human papillomavirus infection[4]have been postulated as the etiological factors. The rare variant of AUFK called multibranched acquired periungual fibrokeratoma was first described in 2014 by Moriue et al.[5] In this letter, we describe one such entity which was successfully diagnosed and treated. AUFK typically affects middle-aged adults with slight male predominance. It is more often localized to toe nails rather than fingernails, most commonly in the periungual area. Our case is unique due to its occurrence in fingernails, and its presentation during the first decade of life in a female. In this, we tried to correlate the histopathological and dermoscopic findings which might help in the preoperative diagnosis of this condition. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.