Images in vascular medicine. 'Ski-jump' toenails--a phenotypic manifestation of primary lymphedema.

A 42-year-old male with long-standing lymphedema presented to discuss therapeutic options for increasing leg swelling. His lymphedema began spontaneously in his midteens and asymmetrically involved both legs. No family history of lymphedema existed. Physical examination was remarkable for minimally pitting bilateral lymphedema extending from the toes to the upper calves. His toenails were diffusely hypoplastic with up-turned concavity consistent with ‘ski-jump’ nails (Panels A and B). This unique ungual appearance is reported to occur in 10–15% of patients with Milroy disease or ‘Milroy-like’ lymphedema.1 Although this subject had primary lymphedema, his age of