RECENTLY three patients presented with lesions of the toe nails and finger nails which closely resemble garlic cloves with the outer skin peeled away. These lesions began, without any history of trauma, as small lumps at the cuticle which grew away from the nail bed; they came to project from the dorsal surface of the nail, loosely attached by a pedicle (Figure). Painless, they did not recur following removal.
Histological appearance was of a benign fibroepithelial polyp or irritation fibroma of the nail bed. Microscopic examination of serial sections revealed no foreign body; the appearance was that of a lesion completely covered, except at the base, by a layer of hyperkeratotic stratified squamous epithelium. The granular layer was prominent, with prickle cell and basal layers of normal thickness. The core of the polypoid structure was composed of interlacing bundles of dense collagenous tissue containing capillary channels.
The lesions described