Diagnostic Challenges and Multidisciplinary Management Strategies for Manicure-Induced Subungual Abscess with Acantholytic Changes

Acantholytic changes are a typical manifestation of the loss of intercellular adhesion in the epidermis, often seen in genetic diseases (such as follicular keratosis) or induced by acquired factors such as infections or trauma. This article reports a case of a 27-year-old female patient who presented with redness, swelling, and pain around the left thumb nail, along with a subungual abscess for one month following a manicure. The diagnostic process highlighted the complexity of both clinical and pathological diagnosis. Initial anti-infection treatments were ineffective, and the patient was subsequently treated with surgical debridement and a fasciocutaneous flap transplant. The patient made a good recovery, but histopathology revealed acantholytic cells and disordered keratinization in the epidermis, requiring differentiation from conditions like Darier’s disease (follicular keratosis) and secondary changes induced by Staphylococcus aureus toxin. This case suggests that: (1) manicure procedures may trigger underlying genetic skin conditions through mechanical injury or chemical irritation; (2) nail fold infections complicated by acantholysis require multidisciplinary collaboration (dermatology, pathology, genetics) and dynamic follow-up data to avoid misdiagnosing rare genetic diseases as other conditions.