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Susan Boiko, MD; Robert A. Kaufman, MD; Anne W. Lucky, MD

Arch Dermatol. 1988;124(3):418-423.

Abstract
• Three children with severe, secondarily infected atopic dermatitis since infancy developed osteomyelitis of the distal phalanges of the hands. The insidious onset of one or more distal subungual black macules was followed by edema, erythema, and pain in the involved fingers. No child had an elevated erythrocyte sedimentation rate or fever, but all had roentgenographic or scintigraphic evidence of bony destruction. In two children, Staphylococcus aureus grew from skin surface cultures; S aureus also grew from nail bed and osseous cultures of the distal phalanges; Streptococcus viridans grew from one child's nail bed. All children had prolonged hospitalizations. In two children, laboratory evaluation of immunologic function disclosed normal findings. We postulate that intense scratching of infected skin coupled with minor trauma to the fingertips created distal subungual microabscesses that spread contiguously to the underlying bone.

(Arch Dermatol 1988;124:418-423)

Author Affiliations
From the Departments of Dermatology (Drs Boiko and Lucky), Pediatrics (Drs Lucky and Kaufman), and Radiology (Dr Kaufman), University of Cincinnati College of Medicine, and the Divisions of Pediatric Dermatology and Radiology, Children's Hospital Medical Center, Cincinnati.

Footnotes
Accepted for publication Sept 17, 1987.

Reprint requests to Department of Dermatology, University of Cincinnati College of Medicine, 234 Goodman St, Mail Location 523, Cincinnati, OH 45267 (Dr Boiko).

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