History:

A 20-year-old male presented with painful and tender periungual swelling involved four fingers of two months duration. About four weeks afte initiating treatment with Isotretinoin 40 mg per day for nodulocystic acne, the patient started to develop erythema, swelling and tenderness at the bases and lateral folds of the involved fingernails. Then distal pyogenic granuloma-like granulation tissue was appeared. The treatment was stopped and the patient was given a combination of topical antibiotic and corticosteroid (Fucicort ointment) applied twice daily. Complete clearance within 4-6 weeks was occurrd. It is important to emphasize that, the main step in treatment of this condition rare however important side effect of systemic retinoids is to stop the offending agent (isotretinoin) especially when the reaction is severe or symptomatic.