Ungual fibrokeratoma

Ungual fibrokeratomas may arise from the most proximal part of the matrix and remain in a supraungual position; arise from the medial portion of the matrix and remain intraungual (dissecting fibrokeratoma); or arise from the distal matrix or nail bed growing entirely under the nail. The lesion is histologically characterized by a dense core of longitudinally arranged collagen, almost complete lack of elastic fibres, oedema in its acral part, and hyperkeratosis of the tip which usually includes dried plasma globules that stain positive with PAS.

Koenen's ungual fibroma—seen in about half of patients with tuberous sclerosis—is historically indistinguishable.

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