Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD
Submitted on: September 18, 2024
CHIEF COMPLAINT: “Two of my nails turned black “
CLINICAL HISTORY:
Signs and symptoms: A 70-year-old female with no past medical history presented to our clinic with greenish-black discoloration of two fingernails on the right hand. She states she first noticed the color change three months ago after removing nail polish. She further states she goes to the nail salon regularly and was instructed to soak her nails in vinegar. She saw her primary care provider two weeks ago and was started on oral terbinafine. She reports no improvement in the discoloration. Patient denies pain, swelling, and discharge. She also denies a history of smoking, alcohol use, illicit drug use, or recent travel. Patient states she has no personal or family history of skin cancer.
PHYSICAL EXAM:
On physical examination, the patient had greenish-black discoloration of the nailfold and onycholysis, without proximal nail fold changes, affecting the first and second digits of the right hand.
LABORATORY TESTS:
N/A
DERMATOHISTOPATHOLOGY:
N/A
DIFFERENTIAL DIAGNOSIS:
1. Pseudomonas Nail Infection
2. Subungual Hematoma
3. Onychomycosis
4. Subungual Melanoma