Pterygium, Nail

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Image of Pterygium, Nail

VisualDx images show variation in age, skin color, and disease stage. VisualDx has 4 images of Pterygium, Nail.

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ICD Codes

ICD-9-CM:
703.8 – Other specified diseases of nail

ICD-10-CM:
L60.8 – Other nail disorders

Synopsis

Pterygium is an abnormality of the nail that can be dorsal or ventral depending on the site of involvement. Dorsal pterygium is the growth of a projection of the proximal nail fold that fuses with the underlying matrix and, subsequently, with the nail bed. As a result, the nail plate is divided into 2 lateral segments that progressively decrease in size as the pterygium widens. Complete involvement of the matrix and the nail bed produces a total loss of the plate and a permanent atrophy of the nail apparatus. Dorsal pterygium is most commonly acquired. It arises from conditions involving the proximal nail fold, such as lichen planus, burns, trauma, radiodermatitis, cicatricial pemphigoid, graft-versus-host disease (GVHD), toxic epidermal necrolysis (TEN), pemphigus foliaceus, and Raynaud phenomenon.

Ventral pterygium (pterygium inversum unguis) consists of a distal expansion of the hyponychium, which anchors to the undersurface of the nail plate, ultimately resulting in the obliteration of the distal nail groove. Ventral pterygium is more common in females. It usually arises from conditions involving the distal nail groove, such as systemic connective tissue diseases (eg, systemic sclerosis, systemic lupus erythematosus, Raynaud disease), scarring in the vicinity of the distal nail groove, use of formaldehyde-containing hardener, subungual exostosis, stroke, and trauma. Ventral pterygium may also be idiopathic, congenital, or sometimes familial.

Both ventral and dorsal pterygium predominantly involve the fingernails. Aside from the nail dystrophy, patients may complain of pain, particularly in the case of trimming the nails of a ventral pterygium.

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