The skin manifestations of AN parallel the disease course, suggesting the presence of circulating antibodies to tumor antigens. Cytokines may play a role. Mortality and morbidity are related directly to the available treatment options for the underlying neoplasm. In most reported cases, cervical lymph node metastases are present at the time of diagnosis, usually indicating a poor prognosis. Mean age of onset is 61 years.
Nails can show severe dystrophy with painful paronychia, subungual debris, and linear striations.
Involvement of the ear helices with a violaceous scaly eruption is a constant finding. With further progression, involvement of the cheeks and nose occurs. In the second stage of AN, a palmoplantar keratoderma is present that also can be violaceous in color. Although the paronychia of the nails may be painful and tender and cracking and fissuring of the fingertips may be seen, the papulosquamous lesions typically are asymptomatic. On further questioning, patients may admit to mild constitutional symptoms, weight loss, and other nonspecific findings of internal malignancy.