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Twenty-nail dystrophy

Trachonychia (meaning "rough nails") is a medical term encompassing a primary disorder of the nail unit that mainly develops as an idiopathic condition. A number of dermatologic, genetic, autoimmune and systemic diseases, however, have been linked with trachonychia. Two types are described: opaque (a more common form in which the nails are brittle, thin, and rough) or shiny trachonychia (superficial ridging and pitting being the main features). Clinical findings are crucial in making the diagnosis.


Trachonychia is a term denoting a type of nail disorder that primarily arises as an idiopathic disorder seen in individuals of all ages and gender [1] [2] [3]. However, a number of isolated reports have described a strong association of trachonychia ("rough nails") with various disorders of genetic, autoimmune, and infectious origin, most important being alopecia areata [1] [2] [4] [5]. Two clinical subtypes are documented in the literature:

  • Opaque trachonychia - The nail surface appears very rough, as if it was rubbed by sandpaper ("sandpaper nails" is often used as a term), and is regarded as the more severe type [1] [3]. In addition, the nails are more fragile and exhibit severe longitudinal ridging, whereas onychoschizia (nail splitting) is also a common feature [2] [3].
  • Shiny trachonychia - Abundant nail pitting and shiny, opalescent nails are the hallmarks of a milder subtype known as shiny trachonychia [1]. Ridging, although present, is not as severe like in opaque trachonychia, and is formed out of the smaller pits [2] [3]. Shiny trachonychia is more commonly associated with alopecia areata than opaque trachonychia, which is why accompanying features of this dermatologic condition (hair loss) might be simultaneously observed [1] [2]. Koilonychia (spoon nails) is a common feature of both subtypes [2].
  • He has held leading positions in various societies, including as President of the European Society for Cosmetic and Aesthetic Dermatology (2003–4), President of the Italian Society of Dermatology and Venereology (SIDeMaST; 2009–10), President of the International[books.google.de]
  • […] location  Show only providers accepting new patients Choose gender Female Male Search health plans accepted Please contact the practice directly to confirm your health plan is accepted Choose preferred language Any language Chinese - Mandarin English Vietnamese[swedish.org]
Congestive Heart Failure
  • Red lunulae occur mainly in congestive heart failure 23 ( Figure 6.27 ), although they can also be observed in patients with many other 6.29 ) disorders or may be idiopathic. Search Pocayo :: Custom Search[pocayo.com]
Heart Failure
  • Failure and Transplantation Cardiology Nita Ahuja MD, MBA Gastrointestinal Surgical Oncology, General Surgery, Minimally Invasive Surgery, Sarcoma and Connective Tissue Surgical Oncology Paul Aiello MD Radiology, Diagnostic Radiology Joseph Akar MD,[yalemedicine.org]
  • Red lunulae occur mainly in congestive heart failure 23 ( Figure 6.27 ), although they can also be observed in patients with many other 6.29 ) disorders or may be idiopathic. Search Pocayo :: Custom Search[pocayo.com]
Pitting Nails
  • What causes pitted nails and what can you do about them? Nail Pitting Causes: Pitted Nails Can Be a Sign of a Medical Problem Pitted fingernails shouldn't be . Tagged: nail pitting. December 29,. Alopecia areata.[vk.com]
  • nail finding in lichen planis pterigium of nail longitude ridges @ trachonychia 20 nail dystrophy tented nail @ puptent sign v shape splitting of nail ventral/inverse pterygium irritant contact dermatitis koebner phenomenon gradually enlarge annular[quizlet.com]
  • Superficial nail abnormalities refer to changes confined to the nail plate surface, for example, trachonychia, pitting, nail ridging and discoloration.[jebmh.com]
  • A pilot study on the role of intralesional triamcinolone acetonide in the treatment of pitted nails in children. Singapore Med J. 2000; 41 :66–68. [ PubMed ] [ Google Scholar ] 54. Halkier-Sørensen L, Cramers M, Kragballe K.[ncbi.nlm.nih.gov]
Cutaneous Manifestation
  • There has been evidence of the condition as a cutaneous manifestation of lichen planus. It has also been associated with other diseases such as eczema , psoriasis, alopecia areata, and atopic dermatitis.[findwords.info]
  • There has been evidence of the condition as a cutaneous manifestation of lichen planus.[medbox.iiab.me]
  • There has been evidence of the condition as a cutaneous manifestation of lichen planus. It has also been associated with other diseases such as eczema, psoriasis, alopecia areata.[dictionnaire.sensagent.leparisien.fr]
  • There has been evidence of the condition as a cutaneous manifestation of lichen planus. It has also been associated with other diseases such as eczema, psoriasis, alopecia areata. It is more common in children and becomes less obvious with age.[salongeek.com]
Skin Lesion
  • Patients were clinically evaluated for evidence of any other skin lesions and biopsy was done if any significant skin lesion was found.[jmscr.igmpublication.org]
  • lesions near the nail. [3] Our patient had all three features.[idoj.in]
  • […] cutaneous diseases Arne Kanig and Rudolf Happle Ichthyoses erythrokeratodermas and related disorders Keratodermas Kro Dariers disease and HaileyHailey disease Daniel Hohl Theodora Mauro and leanPhilippe Gorog Mosaicism and linear lesions Pruritus and dysesthesia[books.google.com]


A comprehensive clinical approach is necessary in order to make the diagnosis of trachonychia. A detailed history, during which patients should be inquired about the onset of symptoms and their progression, is recommended as the first step [1]. A thorough family history of skin disorders is essential; the close inspection of the nails, the skin, the mucosal tissues (the oral cavity) and the hair is perhaps the crucial component of the workup, in order to exclude other dermatologic disorders [1]. Some studies have used the term "twenty-nail dystrophy" or TND as a synonym for trachonychia, indicating the involvement of all twenty nails in the body, but that not may be the case in all patients [1] [3]. Whenever a sandpaper-like appearance of the nails is observed, clinical suspicion towards trachonychia must be raised. Although distinct signs (and the underlying cause that led to this phenomenon) are yet to be solidified, the diagnosis remains on clinical grounds [2], but nail clipping (with subsequent histopathologic examination) is a rather useful method to differentiate between onychomycosis and trachonychia, as both can have a similar clinical presentation [1]. Spongiosis, nail epithelia containing exocytosed inflammatory cells, and signs of lichen planus are main features on histopathology [2] [3]. A longitudinal nail biopsy or obtaining a sample of the nail matrix is somewhat contraindicated because of the invasiveness of the procedures and scarring [2].


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  • Robert Sabat, MD, Head of Psoriasis Research and Treatment Center, Department of Dermatology and Allergy/Institute of Medical Immunology, University Hospital Charité, Berlin, Germany.[books.google.com]
  • What treatment is available for twenty-nail dystrophy ? There is no specific treatment for twenty-nail dystrophy . It is a very difficult condition to treat and often results are unsatisfactory.[dermnetnz.org]
  • There is no treatment for this condition. It is not caused by fungus and is not contagious.[mddermassociates.com]


  • Nuchal nevus pilaris as a skin marker of prognosis in alopecia areata. Nuchal nevus flammeus i ninos areata. Multivariate analisys in alopecia areata: Risk factors and vadility of clinical forms. Alopecia areata in a patient with pili annulati.[keratosis-pilaris-touch.website]
  • Nail changes are not only seen in extensive alopecia areata but may also be present with minimal hair loss and does not imply a poor prognosis for regrowth. Uniform pitting is the most common abnormality seen in alopecia areata.[odermatol.com]
  • It is important to counsel patients on the benign nature of the disease and the generally good prognosis. Even with counseling, some patients may experience distress over their nail changes and request treatment.[ncbi.nlm.nih.gov]


  • The aim of this study to evaluated the clinico- epidemiological characteristics of trachonychia and possible etiologies.[jmscr.igmpublication.org]
  • It is best considered a reaction or morphologic pattern with a variety of clinical presentations and etiologies.[mdedge.com]
  • Nail plate Proximal nail fold Nail matrix Nail bed Hyponychium Chronic dermatitis of proximal nail fold and matrix (adult women, food handlers, house cleaners) Chronic paronychia etiology 1, 2, 3 digits of dominand hand affected Proximal and lateral nail[quizlet.com]
  • Complete loss or only vellus growth – Increased catagen on bx – Isolated patch – 50% associated with a nevus – Eye abnormalities – Post-puberty male – Gradual curling and darkening androgenetic alopecia Acquired Progressive Kinking – AIDS and retinoids are etiologies[brainscape.com]
  • Etiology Most cases of trachyonychia that have been biopsied demonstrate a spongiotic dermatitis. Trachyonychia related to alopecia areata will show a spongiotic dermatitis within the nail matrix histologically.[dermatologyadvisor.com]


  • The aim of this study to evaluated the clinico- epidemiological characteristics of trachonychia and possible etiologies.[jmscr.igmpublication.org]
  • The present study was undertaken to study the different types of nail changes seen in a regular dermatology OPD over a period of one year and prepare an epidemiological data on these findings.[journalijar.com]
  • Childhood psoriasis: an epidemiological survey of 112 patients. PediatrDermatol. 1990;7:19-21 Kumar B, Jain R, Sandhu K et al. Epidemiology of childhood psoriasis: a study of 419 patients from Northern India. Int J Dermatol. 2004;43:654-8 Samman PD.[wwjournals.com]
  • Haeneke E: Epidemiology and Pathology of onychomycosis. In Onychomycosis Nolting S. Korting Eds. Berlin Springer Verlay 1989; 1-8. 6. Williams HC: The epidemiology of onychomycosis in Britain. Br J Dermatol. 1993; 26: 481-490. 7.[odermatol.com]
Sex distribution
Age distribution


  • Pathophysiology The nail changes seen in opaque trachyonychia are caused by inflammation that affects the entire nail matrix and moderates in intensity, but is continuous.[dermatologyadvisor.com]
  • There are several types of onychomycosis that one can differentiate by the initial site of involvement and pathophysiology. The classification of onychomycosis is as follows.2 Distal (or distal lateral) subungual onychomycosis.[podiatrytoday.com]


  • {It is always better to avoid contracting nail fungus,Prevention might be a good idea to cure nail fungus at home when it only started.}[getridofnailfungus101.com]
  • I enjoy helping patients understand how to keep their skin healthy in the present and how to prevent problems in the future."[medstarhealth.org]
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  • The nail bed erythema can also be a clue to ongoing inflammation affecting the nail, and such cases may be considered for active intervention to prevent irreversible onychodystrophy.[idoj.in]
  • Nail pitting : how to recognize pitting nails: treatment & prevention, psoriasis, arthritis, lichen planus, alopecia areata, eczema, pitting in fingernail & toenail .[vk.com]



  1. Haber JS, Chairatchaneeboon M, Rubin AI. Trachyonychia: Review and Update on Clinical Aspects, Histology, and Therapy. Skin Appendage Disord. 2017;2(3-4):109-115.
  2. Jacobsen AA, Tosti A. Trachyonychia and Twenty-Nail Dystrophy: A Comprehensive Review and Discussion of Diagnostic Accuracy. Skin Appendage Disord. 2016;2(1-2):7-13.
  3. Gordon KA, Vega JM, Tosti A. Trachyonychia: a comprehensive review. Indian J Dermatol Venereol Leprol. 2011;77:640–645.
  4. Dogruk Kacar S, Ozuguz P, Polat S. Coexistence of psoriasis, and alopecia areata with trachyonychia in a pediatric patient with Turner Syndrome. Arch Argent Pediatr. 2014;112:e209–e212.
  5. Tosti A, Fanti PA, Morelli R, Bardazzi F. Trachyonychia associated with alopecia areata: A clinical and pathologic study. J Am Acad Dermatol 1991;25:266-70.

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Last updated: 2017-08-09 17:34