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Updated: Aug 20, 2025
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Published on: October 12, 2012
Nail Loss in Mild to Moderate Pemphigus Vulgaris
Ashley Vander Does1, Alexandra Caresse Gamret1, Gil Yosipovitch1
1Dr. Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, Florida, USA.
Introduction:
Symptoms of pemphigus vulgaris (PV) rarely include nail findings. When ungual involvement does occur, the most common manifestations are paronychia and onychomadesis. Onycholysis is very uncommon, and complete nail loss has not been reported in the literature. Ungual involvement is thought to be closely correlated with disease severity, with only severe PV cases demonstrating nail symptoms.
Case Presentation:
We report a case of a 34-year-old female presenting with mild to moderate PV yet severe onycholysis of her first toe leading to secondary nail loss in conjunction with paronychia of her bilateral thumbs. Oral tofacitinib and rituximab infusions led to strikingly rapid improvement in her nail symptoms.
Discussion/Conclusion:
This case illustrates the importance of a thorough history and physical exam, as a primary complaint of nail symptoms in these patients may lead to unrecognized PV by even the most skilled practitioners. Tofacitinib and rituximab in combination may rapidly improve nail involvement.
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