# Onychoscopic Analysis of Cyclophosphamide-Induced Polydactylic Bluish-Gray Discoloration in a Case of Pemphigus Foliaceus

## TL;DR

A rare case of bluish-gray nail discoloration caused by cyclophosphamide treatment in a pemphigus foliaceus patient is described and differentiated from melanoma.

## Contribution

Reports a rare onychoscopic finding of cyclophosphamide-induced nail discoloration in pemphigus foliaceus.

## Key findings

- Bluish-gray nail discoloration occurred in a patient receiving cyclophosphamide for pemphigus foliaceus.
- Onychoscopic analysis helped distinguish the discoloration from nail apparatus melanoma.
- The case highlights the importance of recognizing rare drug-induced nail changes.

## Abstract

Cyclophosphamide, an alkylating agent, has rarely been observed to cause a bluish discoloration of nails, an occurrence that is typically underreported. We describe the case of a middle-aged male undergoing dexamethasone-cyclophosphamide pulse therapy for pemphigus foliaceus, who exhibited bluish-gray discoloration of the nails. It is crucial to differentiate this presentation from other conditions such as nail apparatus melanoma (NAM), which may manifest in a slightly different manner. We also report the onychoscopic findings observed in this case.