(BMJ)—A 56-yo man presented w/ a 10-yr hx of ridges in the center of his nails. Exam: nontender, transverse ridging at center of each nail, w/ loss of nail cuticle, most evident in thumbs. What is the dx?
Onychomycosis
Median nail dystrophy
Subungual verruca
Glomus tumor
Longitudinal melanonychia
You are correct. Median nail dystrophy occurs due to repeated trauma to the nail bed. A tic-like mechanism of trauma occurs whereby repeated pressure on the cuticle—usually pushing by another finger—causes nail bed damage and loss of the cuticle. Tx is challenging, but explanation of the underlying mechanism and protection of the nail bed may be sufficient.

BMJ 2017;356:j1200
By vgreene, 3 July, 2017

LNG