Psoralen ultraviolet A-induced melanonychia
Citations Over Time
Abstract
Conflict of interest: the authors declare that they have no conflicts of interest. A 53‐year‐old white man presented with a 10‐year history of psoriasis affecting the dorsa of both hands. There were no associated nail changes, and the patient's feet were unaffected. His mother had psoriasis, which was being treated with methotrexate. He had failed to respond to topical treatments, including superpotent corticosteroids, combined potent corticosteroid with calcipotriol, and dithranol. Topical hand psoralen ultraviolet A (PUVA) photochemotherapy was commenced, but after 3 weeks of twice‐weekly treatment, there was little benefit. Thus, the treatment was changed to oral 8‐methoxypsoralen (8‐MOP) PUVA. Twice‐weekly treatments were given for 5 weeks (cumulative dose 61.5 J/cm2), but the patient was unable to tolerate treatment due to irritation and blister formation. At follow‐up, the patient was found to have symmetrical longitudinal bands of nail pigmentation affecting all fingernails, but most prominently, his thumbs (Fig. 1a,b). The patient reported onset of these bands within the first week of starting oral PUVA treatment. A number of speckled lentigines were seen over sites of previous plaques of psoriasis on the patient's fingers. New pigmentation was not seen at any other sites, and specifically, the toenails were spared.
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