Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
This 12-year-old boy has developed changes affecting the nails of his hands and feet. Repeated mycology has proved negative. He has no skin problems elsewhere.
There is roughness of the nail plates (trachyonychia) affecting all finger and toenails. With repeatedly negative mycology, and absent skin problems elsewhere, the likely diagnosis is twenty-nail dystrophy.
This may be associated with previous, concurrent, or the ultimate development of alopecia areata or lichen planus. Evidence of these conditions should be sought in the scalp, mouth, and elsewhere on the skin. Less convincing associations are with psoriasis and eczema.
The condition is difficult to treat, but may undergo spontaneous resolution.
For more information, see twenty-nail dystrophy.
