Intended for healthcare professionals

Endgames Spot Diagnosis

A woman with nail changes

BMJ 2020; 368 doi: (Published 06 February 2020) Cite this as: BMJ 2020;368:l7007
  1. Yingyuan Yu, dermatologist,
  2. Yuling Shi, dermatologist
  1. Department of Dermatology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, China
  1. Correspondence to S Yuling shiyuling1973{at}

A 64 year old woman presented with two weeks of redness, pain, swelling, and exudation of the periungual skin around all fingernails and toenails. Examination found she had complete destruction over the nailfolds, and the periungual skin was erythematous with blisters (fig 1).

Fig 1

Damage over the nail folds of finger and toenails

She was treated for bacterial and fungal paronychia without any improvement, and the results of fungal microscopy and culture of periungual skin were negative.

Two weeks later, she developed cutaneous blisters/bullae on the trunk, which were thinly walled and relatively flaccid. The rest of the skin became fragile, and light stroking caused the epidermis to …

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