Vander Does Ashley, Gamret Alexandra Caresse, Yosipovitch Gil
Dr. Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA.
Skin Appendage Disord. 2022 Nov;8(6):504-507. doi: 10.1159/000525462. Epub 2022 Jul 6.
Symptoms of pemphigus vulgaris (PV) rarely include nail findings. When ungual involvement does occur, the most common manifestations are paronychia and onychomadesis. Onycholysis is very uncommon, and complete nail loss has not been reported in the literature. Ungual involvement is thought to be closely correlated with disease severity, with only severe PV cases demonstrating nail symptoms.
We report a case of a 34-year-old female presenting with mild to moderate PV yet severe onycholysis of her first toe leading to secondary nail loss in conjunction with paronychia of her bilateral thumbs. Oral tofacitinib and rituximab infusions led to strikingly rapid improvement in her nail symptoms.
DISCUSSION/CONCLUSION: This case illustrates the importance of a thorough history and physical exam, as a primary complaint of nail symptoms in these patients may lead to unrecognized PV by even the most skilled practitioners. Tofacitinib and rituximab in combination may rapidly improve nail involvement.
寻常型天疱疮（PV）的症状很少包括指甲方面的表现。当出现指甲受累时，最常见的表现是甲沟炎和甲脱落。甲剥离非常罕见，文献中尚未报道过指甲完全脱落的情况。指甲受累被认为与疾病严重程度密切相关，只有严重的PV病例才会出现指甲症状。
我们报告一例34岁女性，患有轻度至中度PV，但她的大脚趾出现严重甲剥离，导致继发性指甲脱落，同时双侧拇指患有甲沟炎。口服托法替布和输注利妥昔单抗使她的指甲症状迅速显著改善。
讨论/结论：该病例说明了全面病史和体格检查的重要性，因为这些患者以指甲症状为主诉时，即使是最有经验的医生也可能无法识别PV。托法替布和利妥昔单抗联合使用可能会迅速改善指甲受累情况。
