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Introduction In Systemic Sclerosis, apart from skin various types of nail appendage involvement are involved. We describe a rare manifestation of nail appendage.Material and Methods A 61-year lady with dcSSc (onset 2022) with clinical features and laboratory features as in table 1 & 2 below.She commenced on mycophenolate mofetil, omeprazole and nifedipine and sildenafil unrelenting Raynauds. She had PUVA for hands and feet and Narrow Band UVB to her whole body for 6 months for evolving flexion contractures in her fingers and generalized skin thickening.She developed nail dystrophy with onycholysis in June 2024 (figure 1). Her nail dystrophy progressed with development of ‘oil spots’, subungual hyperkeratosis and destruction of the distal nail plates (figure 2). She did not have any synovitis, nor skin psoriasis (nor family history of psoriasis) and did not exhibit Koebner’s phenomenon.Fungal infection was excluded. Cetomacrogol + glycerol was used as soap and moisturizer and had a potent topical corticosteroid (mometasone furoate ointment) for her hands and feet and topical minoxidil to promote growth of her abnormal nails.Results Despite topical agents, vasodilators and immunosuppressive therapies, there remained inadequate response. She was enrolled into a clinical trial. Her skin did show signs of improvement. However, she continued to have long-term residual nail abnormalities ( figure 3).Nail changes are very challenging. Nail abnormalities have not been well studied in the SSc cases. Various nail abnormalities have been reported including trachyonychias, scleronychia, subungual hyperkeratosis, brachyonychia, parrot beaking, pterygium inversum unguis, splinter haemorrhages, as well as cuticle abnormalities.In her case, onycholysis could indicate a combination of nail care habit, mechanical injury and PUVA but her nail dystrophy continued to progress despite improved nail care and stopping PUVA. The presence of oil spots, distal nail dystrophy and nail pitting is not a common nail finding in SSc.Overall, her features are a mixed picture of psoriatic nail changes and scleroderma or may represent a more rare presentation of nail disease in SSc, yet not reported ever.Conclusions It is important to be aware of the nail changes in SSc and examination for this should be part of routine examination. Its precise pathophysiology remains to be elucidated likewise the appropriate targeted therapy remains an unmet need.Abstract P.361 Figure 1–3Abstract P.361 Table 1–3