Case presentation An 11-year-old boy presented with progressive nail changes involving all 20 digits. About a month ago, his mother observed diffuse brown discoloration of his fingernails and toenails, which gradually worsened with splitting, ridging, and brittleness (Cover Images A & B). Despite being cosmetically distressing and unresponsive to routine hygiene, the changes were painless.
Medical history Diagnosed with autism spectrum disorder (ASD), anxiety, and gastroesophageal reflux disease Medications: Clonidine, trazodone, and aripiprazole Aripiprazole was started one month ago No recent use of new medications, supplements, or reported trauma No history of photosensitivity, systemic symptoms, or similar prior episodes. No family history of autoimmune disease, inflammatory dermatoses, or onychodystrophy Physical examination Well-nourished, developmentally appropriate male in no…
