
A 31-year-old, otherwise healthy man presents with longitudinal splitting and ridging of the nail plate of both thumbs that had begun several months before. The affected nails appear cracked with a deep medial depression accompanied by dark, lateral projections. The patient’s medical history is unremarkable and he is not taking any medications.
The most likely diagnosis is
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Nail psoriasis
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Median canaliform nail dystrophy
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Onychomycosis (tinea unguium)
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Lichen planus
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Onycholysis
Answer on page 513
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