Non-Melanoma-Associated Dyschromia of the Proximal Nail Fold

Abstract

Subungual melanoma with pigmentation beneath the nail that extends to involve the proximal nail fold is referred to as Hutchinson’s sign. Black or brown subungual discoloration involving the proximal nail fold secondary to other etiologies has been referred to as pseudo-Hutchinson’s sign. Three patients with nail discoloration and concurrent dyschromia of the proximal nail fold are described: a female with a chronic subungual hematoma and pseudo-Hutchinson’s sign, a male with culture-confirmed Pseudomonas aeruginosa (P. aeruginosa) of the nail with green discoloration involving the proximal nail fold, and a male with an acute subungual hematoma with red-purple subungual discoloration affecting the proximal nail fold. PubMed was searched for the following: black, brown, chloronychia, discoloration, dyschromia, green, hematoma, Hutchinson’s sign, nail, nail fold, proximal, pseudo-Hutchinson’s sign, red, subungual melanoma, syndrome. The papers were reviewed and appropriate references evaluated. In conclusion, melanoma-associated black proximal nail fold pigmentation is referred to as Hutchinson’s sign, and non-melanoma-associated black pigmentation has been designated as pseudo-Hutchinson’s sign. Subungual nail plate discoloration extending to involve the proximal nail fold may be black, green, or red-purple in patients with melanocytic and non-melanocytic lesions, bacterial infection (Pseudomonas), and acute subungual hematoma, respectively. Instead of creating a new terminology, we suggest that non-black subungual discoloration (green or red-purple) extending to involve the proximal nail fold be referred to as pseudo pseudo-Hutchinson’s sign.

Fungal Viridionychia: Onychomycosis-Induced Chloronychia Caused by Candida parapsilosis-Associated Green Nail Discoloration

“…Green nail syndrome can be associated with either a singular bacterial infection, a singular fungal infection, or a polymicrobial infection [3][4][5][6][7][8][9][10][11][12]. Single bacterial etiologies for green nail syndrome are caused by gramnegative organisms.…”

Comparative study of cutaneous melanoma and its associated issues between people of African decent and Caucasians

“…Subcorneal hematoma “talon noir” occur secondary to trauma. It presents as a well‐demarcated linear or roundish pigmented patch or nodule on palms or soles and can be differentiated with dermoscopy from CM 42,44 . Pigmented warts caused by Human papillomavirus (HPV), 60,4 and 65 is another differential of CM 41 .…”

“…Furthermore, in PADs, CM in acral sites can be misdiagnosed as a benign disease. These clinical differentials include pigmented warts, hematoma, localized argyria, fungal infections 41,42 . These are lesions which in richly pigmented skin due to a similarity of their clinical presentation may be misdiagnosed as CM.…”

“…These clinical differentials include pigmented warts, hematoma, localized argyria, fungal infections. 41,42 These are lesions which in richly pigmented skin due to a similarity of their clinical presentation may be misdiagnosed as CM. Clinical-pathologic correlation, dermoscopy, light microscopy, electron microscopy, dark field microscopy and immunohistochemistry are required to differentiate these lesions from CM.…”

“…It presents as a welldemarcated linear or roundish pigmented patch or nodule on palms or soles and can be differentiated with dermoscopy from CM. 42,44 Pigmented warts caused by Human papillomavirus (HPV), 60,4 and 65 is another differential of CM. 41 These lesions present clinically as well-demarcated brown to black hyperkeratotic flat plaques or nodules on acral sites.…”