Nail dysplasia and fetal alcohol syndrome. Case report of a heteropaternal sibship.

We found substantial dysplasia of fingernails and toenails in each of four siblings demonstrating other features consistent with a diagnosis of fetal alcohol syndrome (FAS). This aspect of examination is frequently overlooked in routine physical assessments. All four affected teenagers of this heteropaternal sibship demonstrated common features of FAS, including moderate mental retardation, maxillary hypoplasia, an elongated philtrum, and narrow palpebral fissures, as well as absence or dysplasia of two or more nails. Although nail hypoplasia has been previously reported as a minor finding in FAS, a literature review confirmed that nail dysplasia is found in more than 20% of individuals with FAS.