Subungual Verucca Vulgaris

A 26-year-old woman notes the insidious onset of an abnormal nail. The nail plate gradually grew away from the underlying nail bed and then began to elevate in a tented fashion. The patient cut away the distal nail plate and found a papular lesion under the nail that pushed the latter upwards.

Key point: This rough-surfaced subungual papule also shows dilated, thrombosed blood vessels within it (black dots). This is characteristic of a wart.

Treatment: The nail plate was removed and the subungual mass removed by sharp curettage. The resulting bloody defect was elecrodesiccated, and the nail allowed to heal back by secondary intention. By 9 months later, the entire nail had re-grown in proper position.

Note: Subungual squamous cell carcinoma can closely simulate subungual verucca vulgaris, and a small biopsy is indicated before definitive treatment is given.