A 45-year-old black woman presented to the skin clinic of Temple University School of Podiatric Medicine with paronychia at the medial aspect of her right hallux. A mild serous to purulent discharge with mild odor was noted. A small, red, dome-shaped lesion consistent with a pyogenic granuloma was present at the margin of the nail plate and nail fold (Fig. 1). The patient had been seen previously on multiple occasions by another physician who had prescribed soaks and antibiotics and had twice removed the portion of the nail plate that was “ingrown.” The patient stated that following each surgery she had no pain and the nail returned to its normal appearance. Excisional biopsy of the soft tissue revealed a fairly unremarkable picture histologically. Although the overlying epidermis demonstrated increased pigmentation limited to the basal layer, it did not demonstrate any...

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