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- Megan Craddock, MD*
- Lori Prok, MD*
- *The University of Colorado, School of Medicine, Aurora, CO.
AUTHOR DISCLOSURE
Drs Craddock and Prok have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Presentation
A previously healthy 9-year-old boy presents for evaluation of bilateral thumbnail abnormalities. His mother states that the nails have been deformed for approximately 2 years, but she is unable to identify any inciting agent. The patient and mother deny any trauma to the nails such as picking or biting, infection, febrile illness, or recent or past medication use. The patient has no known medical or family history of skin disorders or nail abnormalities. Social history reveals that the boy is a frequent video gamer, specifically using a handheld device requiring thumb operation. He reports frequent daily use of this device.
Examination of the skin and nails reveals a longitudinal groove of the entire bilateral thumbnail plates. Multiple small horizontal grooves radiate from the larger lesion, giving the appearance of an inverted fir tree (Figure). The lunulae are slightly enlarged. There is no associated skin rash. There is no paronychia, and no other nails are affected on either hand. No pain is associated with palpation of the bilateral thumbnails. No additional …
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