• David de Berker


Erythronychia is a sign in a range of diagnoses presenting in different patterns causing redness of the subungual tissues. Disease may be monodactylous or polydactylous. Redness can be as a longitudinal streak arising in the matrix or nail bed. Alternatively it may be a focal blemish in matrix or nail bed. Less focal patterns occupy all or part of matrix or nail bed. Evaluation requires an understanding of the diseases in which it is found which include the spectrum of inflammatory, infective and neoplastic, including in some instances malignancy. Evaluation and sometimes biopsy enable a management plan and prognostication.


Longitudinal Erythronychia Onychopapilloma Glomus tumour Darier’s Warty dyskeratoma Squamous cell carcinoma Bowen’s disease Surgery Dermoscopy Myxoid pseudocyst Amyloid Lichen planus Melanonychia Leuconychia Connective tissue disease Onycholysis Polydactylous Monodactylous 

Supplementary material

978-3-319-65649-6_17_MOESM1_ESM.pdf (37 kb)
Patient Handout (PDF 30 kb)


  1. 1.
    Siragusa M, Schepis C, Cosentino FI, et al. Nail pathology in patients with hemiplegia. Br J Dermatol. 2001;144:557–60.PubMedGoogle Scholar
  2. 2.
    Piskin S, Saygin A, Doganay L, Kircuval D, Gurkan E. Coexistence of Darier’s disease and acrokeratosis verruciformis of Hopf. Yonsei Med J. 2004;45(5):956–9.PubMedGoogle Scholar
  3. 3.
    Jellinek NJ. Longitudinal erythronychia: suggestions for evaluation and management. J Am Acad Dermatol. 2011;64(1):167.e1–11.Google Scholar
  4. 4.
    Cohen PR. Longitudinal erythronychia: individual or multiple linear red bands of the nail plate: a review of clinical features and associated conditions. Am J Clin Dermatol. 2011;12(4):217–31.PubMedGoogle Scholar
  5. 5.
    De Berker D. Erythronychia. Dermatol Ther. 2012;25(6):603–11.PubMedGoogle Scholar
  6. 6.
    Higashi N. Focal acantholytic dyskeratosis. Hifu. 1990;32:507–10.Google Scholar
  7. 7.
    Baran R, Perrin C. Focal subungual warty dyskeratoma. Dermatology. 1997;195:278–80.PubMedGoogle Scholar
  8. 8.
    Baran R, Perrin C. Localized multinucleate distal subungualkeratosis. Br J Dermatol. 1995;133:77–82.PubMedGoogle Scholar
  9. 9.
    De Berker DA, Perrin C, Baran R. Localized longitudinal erythronychia: diagnostic significance and physical explanation. Arch Dermatol. 2004;140(10):1253–7.PubMedGoogle Scholar
  10. 10.
    Gee BC, Millard PR, Dawber RP. Onychopapilloma is not a distinct clinicopathological entity. Br J Dermatol. 2002;146:156–7.PubMedGoogle Scholar
  11. 11.
    Tosti A, Schneider SL, Ramirez-Quizon MN, Zaiac M, Miteva M. Clinical, dermoscopic, and pathologic features of onychopapilloma: A review of 47 cases. J Am Acad Dermatol. 2015. S0190-9622(15)02124-6.Google Scholar
  12. 12.
    Miteva M, Fanti PA, Romanelli P, Zaiac M, Tosti A. Onychopapillomapresenting as longitudinal melanonychia. J Am Acad Dermatol. 2012;66(6):e242–3.PubMedGoogle Scholar
  13. 13.
    Beggs S, Butala N, Heymann WR, Rubin AI. Onychopapilloma Presenting as Longitudinal Erythronychia in an Adolescent. Pediatr Dermatol. 2015;32(4):e173–4.PubMedGoogle Scholar
  14. 14.
    Zaias N, Ackerman AB. The nail in Darier-White disease. Arch Dermatol. 1973;107(2):193–9.PubMedGoogle Scholar
  15. 15.
    Richert B, Iorizzo M, Tosti A, Andre J. Nail bed lichen planus associated with onychopapilloma. Br J Dermatol. 2007;156:1071–2.PubMedGoogle Scholar
  16. 16.
    Bhaskaranand K, Navadgi BC. Glomus tumour of the hand. J Hand Surg (Br). 2002;27:229–31.Google Scholar
  17. 17.
    De Berker D, Goettman S, Baran R. Subungual myxoid cysts: clinical manifestations and response to therapy. J Am Acad Dermatol. 2002;46(3):394–8.PubMedGoogle Scholar
  18. 18.
    Rutnin S, Nguyen JV, Miller CJ, DeHoratius D, Rubin AI. Pregnancy-associated acquired arteriovenous malformation of the nail unit: a novel cause of localized erythronychia. J Cutan Pathol. 2012;39(11):1030–4.PubMedGoogle Scholar
  19. 19.
    Chamberlain AJ, Millard PR, Pryce DW, Dawber RP. Acquired periungual arteriovenous tumour (cirsoid aneurysm). J Eur Acad Dermatol Venereol. 2005;19:255–6.PubMedGoogle Scholar
  20. 20.
    André J, Moulonguet I, Goettmann-Bonvallot S. In situ amelanotic melanoma of the nail unit mimicking lichen planus: report of 3 cases. Arch Dermatol. 2010;146(4):418–21.PubMedGoogle Scholar
  21. 21.
    Harwood M, Telang GH, Robinson-Bostom L, Jellinek N. Melanoma and squamous cell carcinoma on different nails of the same hand. J Am Acad Dermatol. 2008;58(2):323–6.PubMedGoogle Scholar
  22. 22.
    Baran R, Perrin C. Longitudinal erythronychia with distal subungual keratosis: onychopapilloma of the nail bed and Bowen's disease. Br J Dermatol. 2000;143(1):132–5.PubMedGoogle Scholar
  23. 23.
    Dalle S, Depape L, Phan A, Balme B, Ronger-Savle S, Thomas L. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871–4.PubMedGoogle Scholar
  24. 24.
    Cogrel O, Beylot-Barry M, Doutre MS. Subungual squamous cell carcinoma revealed by longitudinalerythronychia. Ann Dermatol Venereol. 2008;135:883–5.PubMedGoogle Scholar
  25. 25.
    Lecerf P, Richert B, Theunis A, André J. A retrospective study of squamous cell carcinoma of the nail unit diagnosed in a Belgian general hospital over a 15-year period. J Am Acad Dermatol. 2013;69(2):253–61.PubMedGoogle Scholar
  26. 26.
    Ormerod E, De Berker D. Nail unit squamous cell carcinoma in people with immunosuppression. Br J Dermatol. 2015;173(3):701–12.PubMedGoogle Scholar
  27. 27.
    Tang N, Maloney ME, Clark AH, Jellinek NJ. A retrospective study of nail squamous cell carcinoma at 2 institutions. Dermatol Surg. 2016;42(Suppl 1):S8–S17.PubMedGoogle Scholar
  28. 28.
    Collins SC, Cordova K, Jellinek NJ. Alternatives to complete nail plate avulsion. J Am Acad Dermatol. 2008;59(4):619–26.PubMedGoogle Scholar
  29. 29.
    Jung HD, Kim JE, Cho BK, Kang H. Longitudinal erythronychia with subungual keratosis: a daughter subungual nail. Clin Exp Dermatol. 2012;37(8):917–9.PubMedGoogle Scholar
  30. 30.
    Goldenberg A, Lee RA, Cohen PR. Acantholytic dyskeratotic acanthoma: case report and review of the literature. Dermatol Pract Concept. 2014;4(3):25–30.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Kavanagh GM, Jardine PE, Peachey RD, Murray JC, De Berker D. The scleroatrophic syndrome of Huriez. Br J Dermatol. 1997;137(1):114–8.3.PubMedGoogle Scholar
  32. 32.
    Baran R, Dawber RP, Perrin C, Drape JL. Idiopathic polydactylous longitudinal erythronychia: a newly described entity. Br J Dermatol. 2006;155(1):219–21.PubMedGoogle Scholar
  33. 33.
    Cohen PR. Idiopathic polydactylous longitudinal erythronychia. J Clin Aesthet Dermatol. 2011;4(4):22–8.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Cohen PR. Longitudinal erythronychia associated with graft-versus-host disease. Skinmed. 2011;9(5):327–9.PubMedGoogle Scholar
  35. 35.
    Sanli H, Arat M, Oskay T, et al. Evaluation of nail involvement in patientswith chronic cutaneous graft versus host disease: a single-center study from Turkey. Int J Dermatol. 2004;43:176–80.PubMedGoogle Scholar
  36. 36.
    Desirello G, Nazzari G, Stradini D, et al. Primary amyloidosis. G Ital Dermatol Venereol. 1988;123:99–101.PubMedGoogle Scholar
  37. 37.
    Kivanc-Altunay I, Kumbasar E, Gokdemir G, Koslu A, Tekkesin M, Basak T. Unusual localization of multiple myxoid (mucous) cysts of toes. Dermatol Online J. 2004;10(1):23.PubMedGoogle Scholar
  38. 38.
    Aldrich CS, Hong CH, Groves L, Olsen C, Moss J, Darling TN. Acral lesions in tuberous sclerosis complex: insights into pathogenesis. J Am Acad Dermatol. 2010;63(2):244–51.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Baran R, de Berker D, Holzberg M, Thomas L. Baran & Dawber’s diseases of the nailsand their management. 4th ed. Hoboken: Wiley; 2012.Google Scholar
  40. 40.
    Peña-Romero AG, Domínguez-Cherit J, Guzmán-Abrego AC. Under-reported finding in acral erythema multiforme. Indian J Dermatol. 2015;60(6):636.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Tunc SE, Ertam I, Pirildar T, Turk T, Ozturk M, Doganavsargil E. Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis? J Eur Acad Dermatol Venereol. 2007;21:497.PubMedGoogle Scholar
  42. 42.
    Jorizzo JL, Gonzalez EB, Daniels JD. Redlunulae in a patient with rheumatoid arthritis. J Am Acad Dermatol. 1983;8:711.PubMedGoogle Scholar
  43. 43.
    Morrissey KA, Rubin AI. Histopathology of the red lunula: new histologic features and clinical correlations of a rare type of erythronychia. J Cutan Pathol. 2013;40(11):972–5.PubMedGoogle Scholar
  44. 44.
    Wilkerson MG, Wilkin JK. Red lunulae revisited: a clinical and histopathologic examination. J Am Acad Dermatol. 1989;20(3):453–7.PubMedGoogle Scholar
  45. 45.
    Baran R, Moulin G. The bidet nail: a French variant of the worn-down nail syndrome. Br J Dermatol. 1999;140(2):377.PubMedGoogle Scholar
  46. 46.
    Lesher JL Jr, Peterson CM, Lane JE. An unusual case of factitious onychodystrophy. Pediatr Dermatol. 2004;21(3):239–41.PubMedGoogle Scholar
  47. 47.
    Baran R, Juhlin L. Drug-induced photo-onycholysis. Three subtypes identified in a study of 15 cases. J Am Acad Dermatol. 1987;17(6):1012–6.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David de Berker
    • 1
  1. 1.Bristol InfirmaryBristolUK

Personalised recommendations