Figure 433

Ventral pterygium in acrosclerosis.

scleroderma associated with Raynaud's phenomenon, disseminated lupus erythematosus, and causalgia of the median nerve. The condition may be idiopathic, congenital, and familial or acquired. A congenital, aberrant, painful hyponychium has been described associated with oblique, deep fractures of the nails. In one case an unusual acquired association of pterygium inversum unguis and lenticular atrophy of the palmar creases was recorded.

Pain in the finger tip from minor trauma and haemorrhages may appear when the distal, subungual area is repeatedly pushed back or the nail cut short. Toe nails are only rarely involved. Subungual pterygium (non-inflammatory) is analogous to the claw of lower primates. In patients suffering from dorsal pterygium (excluding the traumatic or congenital types) the main characteristic is dilatation in the nail fold capillary loops and the formation of a slender microvascular shunt system in the more dilated loops. These changes are visible by capillaroscopy. Table 4.8 lists the well-recognized causes of pterygium. Lichen planus is the most common specific cause of dorsal pterygium. Ventral pterygium is most frequently seen in association with Raynaud's disease and systemic sclerosis.

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