The red fingers syndrome involves the distal portions of the fingers and toes in patients with certain viral infections. The precise mechanism for the lesion is unknown.


Features of the red fingers:

(1) There is erythema of the periungual region and pulp of distal fingers and toes.

(2) The lesions are usually painless.

(3) The lesions blanch under pressure.

(4) Periungual telangiectasia may be present.

(5) Raynaud's phenomenon is absent.

(6) The nail plate is normal.

(7) Bullous lesions and desquamation are absent.


Conditions associated with the syndrome:

(1) HIV

(2) acute or chronic viral hepatitis, typically C

(3) cirrhosis


A skin biopsy of affected skin shows dilated capillaries in the dermis without inflammation.


Differential diagnosis:

(1) drug reaction

(2) lupus erythematosus

(3) dermatomyositis

(4) onychomycosis


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