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THROUGH THE LENS
Year : 2014  |  Volume : 5  |  Issue : 4  |  Page : 552-553  

Pup tent sign


Department of Dermatology, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India

Date of Web Publication10-Oct-2014

Correspondence Address:
Kikkeri Narayanasetty Naveen
Department of Dermatology, No.10, Skin OPD, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad - 580 009, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.142574

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How to cite this article:
Naveen KN. Pup tent sign . Indian Dermatol Online J 2014;5:552-3

How to cite this URL:
Naveen KN. Pup tent sign . Indian Dermatol Online J [serial online] 2014 [cited 2019 Jul 18];5:552-3. Available from: http://www.idoj.in/text.asp?2014/5/4/552/142574

A 26-year-old male presented with generalized multiple, pruritic, violaceous, flat-topped papules on the trunk and limbs with Koebner'sphenomenon. Theexamination of his nails revealed longitudinal groove on the right middle figure, pterygium on the right thumb and index finger [Figure 1] and [Figure 2]. On the left hand, he had longitudinal groove on the nails of thumb and index finger. Pup tent sign was positive in the nail of right ring finger [Figure 3]. The patient refused for the biopsy. The history and clinical examination suggested a diagnosis of generalized lichen planus.
Figure 1: Pterygium on the nail of thumb and index finger of right hand, with longitudinal groove on the middle and ring finger. Note violaceous papules on the dorsum of the hand

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Figure 2: Pterygium on the closer view

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Figure 3: Pup tent sign is demonstrated by viewing the nail on end

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The incidence of nail disease in different forms of lichen planus ranges between 0% and 16%. [1] Fingernails are more frequently affected than toenails, with initial involvement of two or three fingernails before subsequent involvement of the remaining digits. The most common changes are exaggeration of the longitudinal lines and linear depressions, due to slight thinning of the nail plate. These changes usually occur in the context of severe generalized lichen planus. [2] Pterygium unguis is the hallmark of severe nail disease, though it is not specific to lichen planus. It results from a focal destruction of the nail matrix with subsequent scar formation. As the nail plate is not formed at the affected site, the epithelium of the proximal nail fold attaches itself directly to the nail bed epithelium and both grow distally together to produce a wing-like deformity. Pterygium unguis usually affects the fingers and rarely the toes. Discrete red or violaceous papules in the nail bed may lift and split the overlying nail plate longitudinally, and split lateral edges angle forward to give a pup tent appearance. This has been referred as pup tent sign. Here, we report a case of generalized lichen planus with pup tent sign and pterygium. [1]



 
   References Top

1.
Rajababu KK. Nail and its disorders. In: Valia RG, Valia AR, editors. IADVL Textbook of Dermatology. Mumbai: Bhalani Publishing House; 2010. p. 962-3.  Back to cited text no. 1
    
2.
Breathnach SM. Lichen planus and lichenoid disorders. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. Oxford: Wiley-Blackwell; 2010.p. 41.14.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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