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Twenty-nail dystrophy is an idiopathic nail dystrophy that begins insidiously in early childhood. All 20 nails are uniformly affected with excessive longitudinal striations and loss of nail luster. The skin and its ectodermal derivatives are otherwise normal. Twenty-nail dystrophy is believed to be a self-limited abnormality that resolves slowly with age.

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A patient with pulmonary adenocarcinoma had an erythematous inflammatory lesion resembling erysipelas on the chest wall. Results of a skin biopsy disclosed groups of metastatic adenocarcinoma cells in the dermis, subcutaneous tissue, and lumina of the lymphatic vessels. The diagnosis of the inflammatory metastatic carcinoma should be considered in any persistent and therapeutically unresponsive skin eruption that resembles an infectious process. Careful attention to the clinical features, lack of febrile response, and absence of leukocytosis should assist in making the correct diagnosis of a noninfectious process.

No abstract