10-Year History of Pitted Nails.

Previously published Photo Quizzes are now featured in a mobile app. Get more information at http:// www.aafp.org/afp/apps. A 30-year-old white man reported a 10-year history of itchy, scaly fingernails that chipped and fell off easily. The nails were pitted but not painful. All of his fingernails, but none of his toenails, were affected. He also had patches of dry, scaly skin on his scalp, low back, and genitals. He was otherwise healthy. He had been employed as a handyman. His family history was unremarkable. On physical examination, most of the nails were intact but had some proximal erosion. The distal nails were clipped close, but some had separation from the nail bed, with scaling and yellowing distally. Most of the nails displayed pitting, with the periungual area unaffected (Figure 1). The patient had one pink patch with scale on the right temporal scalp, and additional patches on his back and scrotum.