University of Virginia Health System, Charlottesville, Va (Dr. Gish); The Reading Hospital and Medical Center, Pa (Dr. Romero) dsg5n@hscmail.mcc.virginia.edu
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
The authors reported no potential conflict of interest relevant to this article.
The patient hadn’t injured her thumb and it didn’t hurt. So why had her nail turned green?
A 34-year-old woman came to our clinic because she was concerned about her thumbnail, which had turned green. Although her finger didn’t hurt, she was bothered by its appearance.Several months earlier, the woman had sought care at a different clinic because the same nail had become brittle and come loose from the nail bed, which was spongy. The physician advised her that she had onychomycosisand prescribedciclopirox lacquer, but it didn’t help.
Over the next 3 weeks, she noticed a faint green hue developing at the tip of the nail, which expanded and intensified in color (FIGURE). The patient was a mother who worked at home, washed dishes by hand daily, and bathed her children. Her past medical history was significant for type 1 diabetes mellitus and Hashimoto’s thyroiditis. She had no other symptoms.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
