Nailed it? A diagnostic puzzle in an infant

JAAD Case Reports 2026 Open access

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Authors: Rita El Jbeily, Heather R. Gochnauer, Maria Gnarra, Lawrence F. Eichenfield, David O. Schairer
DOI: 10.1016/j.jdcr.2026.02.016
Cited by: 0
References: 3

Abstract

An 8-month-old otherwise healthy female presented to dermatology clinic with a 2-month history of fingernail and toenail dystrophy. Nail changes were persistent despite a 10-day course of cephalexin prescribed by the patient’s pediatrician. Physical examination revealed subungual hyperkeratosis, onycholysis, and proximal paronychia affecting nearly all toenails and fingernails (Figs 1 and 2). The remainder of the exam was unremarkable. A nail clipping was obtained for Periodic acid-Schiff staining, which revealed debris with neutrophils and gram positive cocci.

Fields of Study & Subjects

Nail Diseases and Treatments Dermatological diseases and infestations Oral and Craniofacial Lesions

Publication details

Journal / source
JAAD Case Reports
Volume
75
Pages
190–192
Publication date
14 February 2026
Language
EN