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Endgames Case review

Nails with bloodstained discoloration

BMJ 2021; 375 doi: (Published 13 October 2021) Cite this as: BMJ 2021;375:n1951
  1. Stamatios Gregoriou, assistant professor of dermatology,
  2. Eftychia Platsidaki,, consultant dermatologist, ,
  3. Polytimi Sidiropoulou, resident dermatologist,
  4. Dimitrios Rigopoulos, professor of dermatology
  1. National and Kapodistrian University of Athens; Andreas Sygros Hospital, 16121 Athens, Greece
  1. Correspondence to: S Gregoriou stamgreg{at}

A woman in her 60s presented with a four month history of nail discoloration (chromonychia). On examination, diffuse erythema with a purpuric hue was noted on the nail bed of all fingernails (nail bed haemorrhage), as well as loss of adhesion of the nail to the nail bed (onycholysis) (fig 1). There were no clinical signs on the toenails. The palms and soles presented a fine desquamation that extended all the way to the dorsal surface and the tips. Diffuse alopecia was evident on the scalp. The patient had no other symptoms or signs involving the skin or any other system.

Fig 1

Diffuse purpuric erythema on all fingernails of a 60 year old woman

Six months earlier she had undergone surgery for advanced breast cancer and was started on docetaxel at a dose of 75 mg/m …

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