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Correspondence |

Dorsal Dimelia of the Fourth Toe in a Patient With Incontinentia Pigmenti

Marc Z. Handler, MD; Jasem Alshaiji, MD; Sadegh Amini, MD; Jan Izakovic, MD
JAMA Dermatol. 2013;149(6):761-762. doi:10.1001/jamadermatol.2013.1980.
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Development of a second nail plate on either the plantar or palmar surface of a digit, known as a double nail, is an extremely rare malformation. When dorsalization of the plantar skin is also present, the condition is referred to as dorsal dimelia. Additional findings associated with dorsal dimelia may include loss of flexion creases with absent flexion at the interphalangeal joints and tapering of the distal phalanx seen on radiography. We report herein a case of an affected toe in a patient with incontinentia pigmenti (IP).

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Figure 1. Clinical images of the subject patient with double toenail. A, Double toenail was observed on the plantar surface of the tip of the left fourth digit. B, On the dorsal aspect of the left foot, the double toenail is seen on the fourth digit. Dystrophic nails affect all digits, and no syndactyly is present.

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Figure 2. Radiograph of the left foot demonstrating tapering of the distal phalanges on the second through fourth digits (anteroposterior view). The fourth digit carries the double nail.

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