Psoriasiform and sclerodermoid dermatitis of the fingers with apparent shortening of the nail plate: a distinct entity?

A Caucasian boy, born to unrelated parents, and with no family history of psoriasis or atopy, developed chronic psoriasiform dermatitis on the palmar surface of the fingers when he was a year old. At the age of 6, the dorsal surface acquired a sclerodermoid appearance and the nail plates appeared to be shortened. The disease was unsuccessfully treated topically with emollients, keratolytic agents and corticosteroids. At the age of 9, when he was hospitalized, finger motility was limited and painful, and movements of the hands were impaired. The feet were normal. All the investigations were within normal limits. Histology of a biopsy revealed parakeratosis, acanthosis with papillomatosis, exocytosis and spongiosis. He was treated with a new oral non-steroidal anti-inflammatory drug, nimesulide (100 mg/day for 20 days, and then 50 mg/day for 20 days), and emollients. Marked improvement, and restoration of finger motility, were achieved after the first month of treatment; the nail plates reappeared because of regression of the eponychium.