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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].


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].


  • Magnesium for Depression: A Cure for Depression using Forward: Although this depression treatment by magnesium essay was written originally to address the role of magnesium as a depression treatment, the role of magnesium deficiency as cause of vast other[samhea.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]
  • They may be a sign of an underlying internal disease or disorder so it is vital that correct diagnosis and treatment are achieved. This book is a comprehensive guide to the anatomy, infections, inflammatory disorders and tumours of the nail.[books.google.com]
  • Scheinfeld NS (April 2003). [ Expression error: Missing operand for "Trachyonychia: a case report and review of manifestations, associations, and treatments"]. Cutis 71 (4): 299–302. PMID 12729094 .[dictionnaire.sensagent.leparisien.fr]


  • 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]


  • 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]


  • Gupta showed that in one of his large epidemiologic studies and I’d like him to talk about that with tinea pedis also.5 There are a number of complications that occur among patients with tinea pedis and diabetes.[podiatrytoday.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]


  • {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]
  • 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