A case of twenty nail dystrophy affecting a 12 year old boy

Nail diseases in children may be congenital or acquired and occurs in 3 to 11% of pediatric population. Twenty nail dystrophy is a nail disorder with a classical presentation, often affecting all twenty nails. It is an idiopathic disorder in childhood but can be associated with other diseases such as lichen planus, alopecia areata, psoriasis, eczema, IgA deficiency, atopic dermatitis, ichthyosis vulgaris and vitiligo. Twenty nail dystrophy is otherwise called trachyonychia. Typically, the condition is bilateral and symmetrical affecting all the nails of hands and feet. It is cosmetically disfiguring and can be source of anxiety for children and parents, which can impact further the quality of life. Twenty nail dystrophy is of two types, based on the clinical presentation namely opaque or shiny trachyonychia. Since this nail disorder is associated with a number of dermatologic diseases, children require long term follow up. We report a case of a 12-year-old boy with a three-year history of twenty nail dystrophy with no relevant family history of skin or nail diseases. The child had isolated nail manifestation without any other dermatologic condition. Twenty nail dystrophy is a self-limiting disease, which is treated conservatively. The aim of this report is to highlight importance of a thorough physical examination to diagnose nail disorders in early stages, which will be helpful to clinicians to distinguish the different nail conditions and associated illness and decide on the correct management. It is important to counsel the family about the benign nature of the disease and good prognosis.

Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study

BACKGROUND: Despite efforts to treat trachyonychia, there is no promising treatment modality. OBJECTIVE: This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia. METHODS: A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physician's global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points. RESULTS: After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients. CONCLUSION: This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.

Psoriasis y alopecia areata con traquioniquia concurrente en una paciente pediátrica con síndrome de Turner / Coexistence of psoriasis, and alopecia areata with trachyonychia in a pediatric patient with Turner Syndrome

El síndrome de Turner es un trastorno genético caracterizado por anomalías del cromosoma X. Se ha descrito en asociación con muchas enfermedades autoinmunitarias y con dermatosis como psoriasis, vitiligo y alopecia areata. La traquioniquia se caracteriza por el aspecto opaco irregular de la lámina ungueal de las 20 uñas. Puede manifestarse en forma idiopática o puede estar asociada con otras dermatosis. En este documento, presentamos el caso de una niña de seis años de edad con síndrome de Turner y diagnóstico de psoriasis, alopecia areata y traquioniquia, y quisiéramos remarcar una posible relación entre estas enfermedades.

Turner syndrome is a genetic disorder characterized by abnormalities of the X chromosome. An association with many autoimmune diseases is described as well as skin diseases such as psoriasis, vitiligo and alopecia areata. Trachyonychia is characterized by irregular opaque appearance on the nail plate of all 20 nails. It may be idiopathic or it can be associated with other dermatological diseases. Herein, we present a 6 years old girl with Turner syndrome who had diagnoses of psoriasis, alopecia areata and trachyonychia and we would like to draw attention to the possible relationship between these diseases.

Trachyonychia: A comprehensive review.

Trachyonychia or rough nails, may present as an idiopathic disorder of the nails or it can be associated with other dermatological conditions. The dystrophic nail findings seen in trachyonychia are characterized by brittle, thin nails, with excessive longitudinal ridging. The most common histopathologic features associated with trachyonychia are spongiosis and exocytosis of inflammatory cells into the nail epithelia; typical features of lichen planus or psoriasis can also be detected. Determining the cause of trachyonychia is challenging. Treatment is often unsatisfactory, although in general it should be aimed at the underlying cause, if found. In most cases, the nail abnormalities improve spontaneously.