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.

Therapeutic Efficacy of Combination Therapy Using Oral Cyclosporine with a Dietary Supplement (Pantogar®) in Twenty-Nail Dystrophy

BACKGROUND: Twenty-nail dystrophy (TND) is an acquired idiopathic disease characterized by dull, thin, lusterless, and fragile nails with fissuring, small regular pits, and excessive longitudinal ridging. Although various treatment modalities have been performed in order to treat TND, the effects of these treatments are controversial. OBJECTIVE: To evaluate the effectiveness of oral cyclosporine in TND. METHODS: A total of 38 patients with TND were treated with combination therapy using oral cyclosporine with a pantothenic acid complex-based dietary supplement (Pantogar®; Merz Pharmaceuticals GmbH, Germany), whereas 44 patients were treated with the pantothenic acid complex-based dietary supplement alone. The therapeutic efficacy in each group was retrospectively evaluated using medical records and clinical photographs. RESULTS: The cyclosporine therapy group had significantly more patients whose improvement was rated as almost clear, marked, or moderate compared to the control group (p<0.001). While the mean CHATS (Color, Hyperkeratosis, Area, Thickness, Separation) score of the cyclosporine therapy group was decreased by 13.45 (from 30.95 to 17.5) after treatment, the mean CHATS score of the control group was only decreased by 8 (from 29.43 to 21.43, p<0.001). Moreover, greater Dermatology Life Quality Index changes after treatment were observed in the cyclosporine therapy group (p=0.085). CONCLUSION: Oral cyclosporine can be a valuable therapeutic option in patients with TND.

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.

A Case of Twenty Nail Dystrophy Treated with Topical Tretinoin Application / 대한피부과학회지

Twenty-nail dystrophy is a distinctive pattern of nail changes, in which all 20 nails are uniformly affected with excessive longitudinal ridging and loss of luster. It occurs at any age ranging from children to adulthood, however, it is most commonly diagnosed in children. It can be idiopathic or caused by other inflammatory dermatoses, but the exact cause and pathogenesis of these changes are so far unknown. Several treatment modalities have been employed for treatment of twenty-nail dystrophy, such as topical steroid, intralesional steroids injection, and topical PUVA, however, without much success. We herein report a case of an adults, patient with twenty-nail dystrophy which was successfully treated with topical 0.025% Tretinoin cream.

Two Cases of Twenty-Nail Dystrophy

Twenty-nail dystrophy is an idiopathic nail dystrophy in which all twenty nails are uniformly and simultaneously affected with excess longitudinal ridging and loss of lustre. The pathogenesis is controversial, and the treatment is unsuccessful. It is thought to have a self-limiting and reversible nature when it develops in childhood, but in adults, it is unusual and exists persistently. We re-port here two cases of adult patients with dystrophy of all twenty nails, whose ages were 58 and 55. The disease had been present for one year and may be associated with alopecia areata in the 58 year old and an idiopathic condition in the 55 year old. Negative results were obtained on mycological studies. Biopsies taken from the nail bed revealed marked hyperkeratosis consistent with nail dystrophy.

Twenty Nail Dystrophy in Two Siblings / 대한피부과학회지

Two siblings, a 42-year-old man and his 39-year-old sister, have had severe twenty nail dystrophy which began to develop in adulthood. The nails are variably involved and show thickening, ridging, koilonychia, opalescence, and loss of luster. There is no evidence of other skin disorders such as psoriasis, lichen planus, or alopecia areata. No other family members through three generations have had similar nail changes. Our cases are unique in that severe twenty nail dystrophy may concurrently affect two siblings during adulthood.

A case of twenty-nail dystrophy associated with chronic thyroiditis and universalis / 대한피부과학회지

Twenty-nail dystrophy is a rare entity in which all 20 nail are uniformly and simultaneously affected with excess longitudinal ridging and loss of luster. This condition is thought to be idiopathic but, many cases are associated with alopecia areata, lichen planus, psoriasis, and ichthyosis. In such cases, it has been hypothesized that immunplogical disorders could play a role in pathogenesis. A 29-year-old male patient presented with dystrophic nail chatge on his all finger and toe nails for 3 years. On phisical examination, all nails were uniformly affected with longitudinal ridging and loss of luster and all body hairs were lost. Thyroid scan showed a finding of chronic thyroiditis. Herein we report a case of twenty-nail dystrophy associated with chronic thyroiditis and alopecia areata.