Pterygium of Fingernails due to Osteoarthritis of Distal Interphalangeal Joints

Abstract

Pterygium is an uncommon nail disorder in which the distal nail bed adheres to the ventral surface of the nail plate with obliteration of the distal nail groove. Pterygium is almost pathognomonic for lichen planus of the nail; however, it can be seen in nail-patella syndrome and in other destructive conditions such as trauma, peripheral vascular disease, Raynaud’s phenomenon, radiotherapy, infection, stroke, and immunobullous disease. Nail involvement associated with primary interphalangeal osteoarthritis of the hand, including leukonychia and longitudinal nail ridge are reported, and osteoarthritis of distal interphalangeal joints may be associated with pterygium, too. Here we presented a 67-year-old female patient with nail alterations at right hand, and pain at distal interphalangeal joints. She reported onset of changes of the fingernails for the past 1 year. She had any systemic disorder. Physical examination of the right hand revealed the diagnosis of pterygium at thumb, index, and ring fingernails. She had Heberden’s nodes. The patient had no evidence of lichen planus, and connective tissue diseases. Hand roentgenogram showed osteoarthritis of distal interphalangeal joints. We thought that the most probable reason of the pterygium in our patient was the osteoarthritis of the distal interphalangeal joints which interfered with local blood flow.