A man aged 55 years presented with a several-year history of dystrophic, somewhat yellowed toenails (particularly affecting both great toes). He was mildly obese and took atorvastatin (Lipitor) for treatment of high cholesterol. His nails and the surrounding skin did not itch, burn, or hurt. The patient reported that his mother and father had similar-appearing nails. BP and pulse were within normal limits. Histologic examination of the nails revealed hyphae in the keratin. Liver function tests were within normal limits.
A woman aged 32 years taking no oral medications presented with thumbnails exhibiting horizontal grooves. A sample of the affected nails revealed no fungal infection. The patient explained that she habitually rubbed her thumbnails. While this process was being assessed, the woman was diagnosed with erythema annulare centrifugum and treated with oral terbinafine (Lamisil) and itraconazole (Sporanox) to eliminate any occult fungal infection. This treatment had no affect on her nail eruption.