Clinical Quiz
The Hong Kong Practitioner VOLUME 26 / September 2004

A boy presenting with nail deformity
H F Ho ¦ó¼yÂ×


A monthly clinical quiz is published in The Hong Kong Practitioner. Readers are invited to participate and a prize draw, sponsored by Pfizer Corporation Hong Kong Limited, will be undertaken among the successful entries each month. For entry into the draw, simply answer the question, fill in the reply slip and return it to the College by 11 October, 2004. Each reader is allowed to submit one entry only. The name of the winner and the answer will be published in the October issue.

Clinical history:

A 6 years old boy was brought to us by his mother presenting with one year history of roughening of his finger nails. It started first on his right ring finger and now involved all ten fingers. Treated empirically as fungal infection with topical medication and a month's oral medication, the nails showed no improvement. The boy enjoyed good health other than this nail problem.

Physical examination showed pitting of all ten finger nails and a few pits on the nails of his right foot on close examination. While pitting was the feature of all the involved nails, some nails showed the features of ridging and grooves and the right ring finger surface had a sand paper-like quality.

Examination of other body parts showed no features of skin diseases. The oral mucosal surface was normal.

The slide and the question were prepared by:
Dr H F Ho, FHKAM(Med)
Specialist (D&V),
i/c Chai Wan Social Hygiene Clinic, Social Hygiene Service, Department of Health.

The most probable diagnosis is:

A. Psoriasis nail dystrophy
B. Onychomycosis
C. Twenty-nail dystrophy of childhood
D. Habit-tic dystrophy

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