Yasuyuki Fujita, MD, Yukiko Tsuji-Abe, MD, Kazuko C

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Nail dystrophy and blisters as sole manifestations in myeloma-associated amyloidosis  Yasuyuki Fujita, MD, Yukiko Tsuji-Abe, MD, Kazuko C. Sato-Matsumura, MD, PhD, Masashi Akiyama, MD, PhD, Hiroshi Shimizu, MD, PhD  Journal of the American Academy of Dermatology  Volume 54, Issue 4, Pages 712-714 (April 2006) DOI: 10.1016/j.jaad.2005.12.031 Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Clinical features and histopathologic findings. A, Brittleness, longitudinal ridging and lamellar splitting of the nail plates were seen on fingernails. B, Biopsy specimen from nail bed of patient's right forefinger demonstrated mild eosinophilic deposits within dermal papilla (arrow). C, Direct fast scarlet staining showed orange amyloid deposits clearly. D, Tense bullae, easily induced by mechanical stimuli, were observed on forearms. E, Biopsy specimen from blister on forearm revealed subepidermal separation and eosinophilic deposits (arrowheads) on superficial dermis. F, Orange deposits were observed beneath bulla and dermal papilla, resistant to potassium-permanganate. (B and E, Hematoxylin-eosin stain; C and F, direct fast scarlet stain; original magnification: B, C, E, F, ×40.) Journal of the American Academy of Dermatology 2006 54, 712-714DOI: (10.1016/j.jaad.2005.12.031) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Fluorescence antigen mapping. A, Antibody directed against type IV collagen (CIV22) mapped to bottom of bulla. B, On top of bulla, antibody against β4 integrin (3E1) was noted at separation of blister roof. (A and B, original magnification ×40.) Journal of the American Academy of Dermatology 2006 54, 712-714DOI: (10.1016/j.jaad.2005.12.031) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions