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Year : 1996  |  Volume : 62  |  Issue : 4  |  Page : 264-265

Onychomadesis in stevens johnson syndrome

Correspondence Address:
Sandhya Acharya

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Source of Support: None, Conflict of Interest: None

PMID: 20948076

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How to cite this article:
Acharya S, Balachandran C. Onychomadesis in stevens johnson syndrome. Indian J Dermatol Venereol Leprol 1996;62:264-5

How to cite this URL:
Acharya S, Balachandran C. Onychomadesis in stevens johnson syndrome. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2019 Sep 15];62:264-5. Available from: http://www.ijdvl.com/text.asp?1996/62/4/264/4414

  To the Editor, Top

Loss or partial loss of the nail may result from a bullous eruption affecting the tips of the digits. Any drug that can induce bullae may cause nail changes or nail loss due to destruction of the nail matrix.[1] We report a case of onychomadesis and temporary shedding of the nails following Stevens Johnson syndrome.

A 28-year-old male on treatment with antituberculous drugs (INH, rifampicin, thiacetazone) developed generalised pruritus, erythema and bullous eruptions. Bullae were seen over the trunk and extremities including the fingers and toes. Ocular involvement manifested as congestion and discharge. Oral and genital erosions were also present. Stevens Johnson syndrome was suspected and the antituberculous drugs were withdrawn. Oral steroids (prednisolone-30mg/day) was started. The lesions subsided with desquamation and post-inflammatory hypopigmentation. Six weeks later, proximal separation and shedding of all the nails over the fingers and toes was observed. Clinically some nails showed onychomadesis and the rest of his fingers and toes showed anonychia. No treatment was advised and two months later new nails had started appearing.

Nail plate deformity and frequently complete shedding with scarring are seen in severe erythema multiforme type of drug reaction to sulphonamides, phenytoin, and barbiturates.[2]

Permanent anonychia after Stevens Johnson syndrome has been reported.[3] Temporary loss has been described due to large doses of cloxacillin and cephaloridine.[4] Onychomadesis has been observed in pemphigus vulgaris.[5]

In the case presented above, the temporary nail changes may be due to involvement of the proximal nail folds by vesicles, the inflammation being severe enough to overwhelm the nail matrix.

  References Top

1.Samman PD. The nails in disease. London: William Heinemann Medical Books, 1972:61-5.  Back to cited text no. 1  [PUBMED]  
2.Moschella SL, Hurley HJ. Disorders of the nails. In: Dermatology. Philadelphia: W B Saunders, 1992:1577.  Back to cited text no. 2    
3.Wanscher B, Thormann J. Permanent anonychia after Stevens Johnson syndrome. Arch Dermatol 1977;113:970.  Back to cited text no. 3  [PUBMED]  
4.Eastwood JB, Curtin JR, Smith EKM, et al. Shedding of the nails apparently induced by large amounts of cephaloridine and cloxacillin in 2 anephric patients. Br J Dermatol 1969;81:750-2.  Back to cited text no. 4    
5.Balachandran C, Naik RPC. Onychomadesis in pemphigus vulgaris. Ind J Dermatol Venereol Leprol 1984;50:31.  Back to cited text no. 5    


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