Periungual fibroma - Nail and Distal Digit
Onset of periungual fibromas is typically in the second decade and as late as the fifth decade of life. Periungual fibromas are rarely reported in children younger than 5 years. No differences between sexes or among different ethnicities or races have been reported. Periungual fibromas are occasionally painful, and some are precipitated by trauma. They are more common on the toes than fingers.
Nontraumatic periungual fibromas are a major diagnostic criterion for the diagnosis of TSC. However, patients with a preceding history of trauma should also be examined for manifestations of TSC. In TSC, periungual fibromas are usually the last skin finding to present and subungual fibromas are a further, less frequent finding. "Red comets" (erythronychia) and longitudinal grooves may be found in the nails of patients with TSC, and these findings should increase clinical suspicion of TSC, even in the absence of periungual fibromas.
There is one case report of a periungual fibroma in a patient with Birt-Hogg-Dubé syndrome.
D21.9 – Benign neoplasm of connective and other soft tissue, site unspecified
264561009 – Periungual fibroma
Differential Diagnosis & Pitfalls
- Infantile digital fibroma – usually occurs on the distal or lateral aspects of the digits, sparing the great toes
- Acral fibrokeratomas – usually occur on the fingers and do not disrupt the nail
- Supernumerary digit – present at birth, usually presents on the medial / ulnar side of the fifth digit
- Verruca vulgaris – lesions often have brown or black dots (thrombosed capillaries) centrally
- Lobular capillary hemangioma (pyogenic granuloma) – rapidly growing, exophytic, easily bleeds with hemorrhagic crust, has a glistening appearance
- Foreign body reaction
- Brittle nail syndrome
- Darier disease