[Permanent nail changes following gold therapy].

Area of Science:

• Rheumatology
• Dermatology
• Toxicology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease.
• Gold salts have been used historically for RA treatment.
• Adverse effects of gold therapy require careful monitoring.

Observation:

• A patient undergoing gold therapy for RA developed a transient rash.
• The patient experienced onycholysis (nail loss) in multiple fingernails and toenails.
• Permanent nail deformities, including longitudinal streaks, thinning, and fragility, were observed post-therapy.

Findings:

• Intracutaneous testing confirmed a delayed-type allergic reaction to the commercial gold solution.
• Nail dystrophy is a potential, permanent adverse effect of gold therapy.
• The observed nail changes are consistent with an immune-mediated response.

Implications:

• This case highlights the risk of permanent nail dystrophy as an adverse reaction to gold therapy.
• Clinicians should be aware of dermatological side effects, including nail changes, associated with gold treatment.
• Delayed-type hypersensitivity may underlie gold-induced nail deformities in rheumatoid arthritis patients.