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10.25259/JSSTD_32_2019
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Pseudo-Hutchinson’s sign – Unraveled by dermoscopy

Department of Dermatology, Government Medical College, Kozhikode, Kerala, India
Department of Dermatology, VIRK Hospital Private Limited, Karnal, Haryana, India
Corresponding author: Dr. Ruovinuo Theunuo, Junior Resident, Department of Dermatology, Government Medical College, Kozhikode, Kerala. truovinuo@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Theunuo R, Mann P, Paul N. Pseudo-Hutchinson’s sign Unraveled by dermoscopy. J Skin Sex Transm Dis 2020;2(1):65-6.

A 13-year-old boy presented with a history of asymptomatic black band on the nail of the right little finger of 1 year duration. On examination, he manifested a brown-black linear band of 2 mm width with regular borders and striate leukonychia on the right little finger [Figure 1]. Black pigmentation extending to proximal nail fold was observed. Dermoscopy revealed a regular patterned brown-black band of 2 mm width with homogeneity of color and width of each individual line [Figure 2]. The black pigmentation extending to proximal nail fold was found to be the nail plate pigmentation visible through a translucent cuticle, known as pseudo- Hutchinson’s sign [Figure 3]. A diagnosis of longitudinal melanonychia secondary to benign melanocytic proliferation was made (nevus/lentigo).

Figure 1:: Clinical picture of a patient manifesting melanonychia.
Figure 2:: Dermoscopic picture of longitudinal melanonychia revealing regular patterned brown- black band of 2 mm width with homogeneity of color and width of each individual band (Dino-Lite Dermoscope, polarized light, ×10).
Figure 3:: Dermoscopic picture of Pseudo-Hutchinson sign-nail plate pigmentation visible through a translucent cuticle (Dino-Lite Dermoscope, polarized light, ×10).

Pseudo-Hutchison’s sign is a reflection of the pigmentation of nail bed and nail matrix through the transparent nail folds, whereas Hutchinson’s sign is a feature of subungual melanoma where brown-black pigmentation from longitudinal melanonychia extends onto the proximal and lateral nail folds.

Melanonychia assumes significance since it can be a manifestation of nail apparatus melanoma. Apart from Hutchinson’s sign, other warning signs that should raise suspicion of melanoma manifesting as melanonychia include onset during fourth decade of life or later, personal or family history of melanoma or dysplastic nevus syndrome in the affected, dystrophy of the affected nail, width of pigmentation >3 mm, blurred and indistinct margins or variations in band color, and widening or darkening of pigmentation proximally.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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