Nail involvement in pemphigus vulgaris (PV) is an unusual clinical finding. The most common clinical manifestations include chronic paronychia and onychomadesis. We report an adult female patient with PV who initially presented with chronic paronychia of multiple fingernails and toenails before the onset of vesiculobullous eruptions. Later on, after complete resolution, there was recurrence of pemphigus presenting as hemorrhagic paronychia of the left index finger. Systemic treatment with corticosteroids and azathioprine led to complete resolution of mucocutaneous lesions as well as nail manifestations. Thus, chronic treatment-resistant paronychia may be an early and important sign of generalized pemphigus in certain patients.
Pigmented transverse nasal band (PTNB) is an interesting morphological entity mainly of cosmetic concern. It is believed to be related to a defect in the development of the nasal cartilages and bones from childhood to adolescence. Some patients may have genetic predisposition. It is asymptomatic in nature and may be associated with certain dermatological conditions such as seborrheic diathesis, dermatosis papulosa nigra, ichthyosis, atopic dermatitis, acne vulgaris, psoriasis, and seborrheic melanosis.
Leprosy is a chronic granulomatous infectious multisystem disease that may present with protean manifestations. It mimics many systemic and dermatological disorders. Here we report a case in which an elderly female presented with malar rash, intermittent fever, and arthralgia. Her diagnosis was significantly delayed due to a close clinical resemblance to systemic lupus erythematosus. It is important to be aware of such manifestations of leprosy and improve awareness of it in clinicians to avoid misdiagnosis and delay in treatment.
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