Nail pitting and onycholysis.

A previously healthy man, 43 years of age, was referred to the dermatology department with a one-year history of fingernail onychomycosis. His condition was refractory to oral antifungal treatment (terbinafine 250 mg QD for three months). On physical examination, nail pitting and onycholysis affecting seven fingernails was noted (Figure 1A). He also had mild erythematous silvery-white scaly patches in the left external ear canal (Figure 1B) and slight, fine scaling of the scalp, which was associated with mild pruritus. No other skin lesions were detected.