Nailfold Signs CTD — SCE Dermatology MCQ

Correct answer: A — Connective tissue disease — periungual erythema, ragged cuticles, and nail fold capillary changes should prompt investigation for dermatomyositis, SLE, or systemic sclerosis

The best answer is “Connective tissue disease — periungual erythema, ragged cuticles, and nail fold capillary changes should prompt investigation for dermatomyositis, SLE, or systemic sclerosis”. Nail findings localise disease to matrix, bed or periungual tissue; a new changing longitudinal pigmented or erythronychic band requires specialist assessment because benign and malignant causes overlap. The alternatives “Chronic paronychia from repeated wet-work exposure, after clinicopathological correlation, after specialist assessment, when the full phenotype supports it, within an appropriate UK pathway”, “Nail psoriasis with matrix and nail-bed inflammation, after specialist assessment, when the full phenotype supports it, within an appropriate UK pathway”, “Onychomycosis with dermatophyte invasion of the plate, when the full phenotype supports it, within an appropriate UK pathway, after clinicopathological correlation”, “Habit-tic deformity from repetitive proximal-fold trauma, within an appropriate UK pathway, after clinicopathological correlation, after specialist assessment, when the full phenotype supports it” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: DermNet specialist nail terminology reference: https://dermnetnz.org/topics/nail-terminology