case_images: PMC9666851_01
case_images: Initial presentation. (a) Inflamed, purulent, and dystrophic nails of the
  3rd, 4th, and 5th digits of the left hand. (b) Flexion contracture of the
  PIP joints of the 3rd, 4th, and 5th digits of the left hand. (c) Jaccoud's
  arthropathy of the left hand shows a visible deformity with an absence of
  damage to either bone or cartilage.
case_images: 10.1177_2050313X221136766-fig1.jpg
case_images: PMC9666851_01_10.1177_2050313X221136766-fig1.jpg
case_images: fig1-2050313X221136766
case_images: Inflammation, dystrophy, and "lakes of pus" in the nails of the 3rd, 4th, and 5th digits of the left hand were noted (Figure 1(a)). The digits were tender, and the affected fingers resembled the Boutonniere deformity of rheumatoid arthritis (Figure 1(b)). Bone erosion was likewise absent on the hand X-ray (Figure 1(c)).
case_images: (a-c) After 1 month of clobetasol propionate 0.05% ointment: Thick, crumbled,
  dystrophic, and onycholytic nails, surrounded by xerotic skin.
case_images: 10.1177_2050313X221136766-fig2.jpg
case_images: PMC9666851_01_10.1177_2050313X221136766-fig2.jpg
case_images: fig2-2050313X221136766
case_images: On follow-up a month after discharge, the pustules partially dried up but the nails were still thick, crumbled, dystrophic, and onycholytic with dry periungual skin (Figure 2(a)-(c)); clobetasol propionate 0.05% ointment was continued due to the partial improvement seen.
case_images: Evolution of lesions with clobetasol propionate 0.05% ointment. (a) After
  6 months. (b) After 17 months.
case_images: 10.1177_2050313X221136766-fig3.jpg
case_images: PMC9666851_01_10.1177_2050313X221136766-fig3.jpg
case_images: fig3-2050313X221136766
case_images: After 6 months, the pustules were gone and new nails were growing out (Figure 3(a)). After 17 months of daily application of clobetasol propionate 0.05% ointment with two-week breaks in between to prevent atrophy, the nails became brittle and onycholytic (Figure 3(b)), prompting the change to calcipotriol/betamethasone dipropionate ointment once a day.
case_images: Evolution of lesions with calcipotriol 50 mcg/betamethasone dipropionate
  500 mcg ointment. (a) Significantly better cosmetic improvement after
  2 weeks. (b) Progressive growth of normal nails without scaling and
  periungual desquamation after 4 weeks.
case_images: 10.1177_2050313X221136766-fig4.jpg
case_images: PMC9666851_01_10.1177_2050313X221136766-fig4.jpg
case_images: fig4-2050313X221136766
case_images: After only 2 weeks on this combination, significantly better cosmetic appearance was achieved (Figure 4(a)). At 4 weeks, the nail plate and the periungual area were free from scales with new normal-looking nails (Figure 4(b)).