Can you identify these nail lesions?

A 47-year-old woman seeks evaluation of asymptomatic lesions on the edges of 1 fingernail. She first noticed the lesions several months ago.

Which of the disorders in the differential is the likely culprit?

A. Chronic paronychia.

B. Acute paronychia.

C. Psoriasis.

D. Warts.

E. Dermatophyte infection.

(Answer on next page)

Case 2: Periungual warts

This patient has periungual warts, D. Imiquimod eradicated these warts; cryosurgery is another option. When the area beneath the nail is involved, this stubborn condition can pose a treatment challenge.

The absence of signs and symptoms of the other disorders in the differential supported the diagnosis of periungual warts. Unlike warts, psoriasis and dermatophyte infections commonly affect the nail plate. Paronychias usually are painful.