Trachonychia

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Prab R. Tumpati, MD — Editor-in-Chief, WikiMD Medical Encyclopedia
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Trachonychia
Trachonychia affecting the fingernails
Synonyms	Twenty-nail dystrophy
Pronounce	N/A
Specialty	N/A
Symptoms	Rough, brittle, thinning, discolored nails
Complications	Nail dystrophy
Onset	Childhood or adulthood
Duration	Chronic
Types	N/A
Causes	Idiopathic, lichen planus, alopecia areata
Risks	Genetic predisposition
Diagnosis	Clinical examination, biopsy
Differential diagnosis	Onychomycosis, psoriasis, eczema
Prevention	N/A
Treatment	Topical corticosteroids, systemic therapy, phototherapy
Medication	N/A
Prognosis	Variable, often benign
Frequency	Rare
Deaths	N/A

A condition affecting the nails, often associated with lichen planus

Trachonychia, also known as "twenty-nail dystrophy," is a condition characterized by rough, thin, and brittle nails. It can affect both fingernails and toenails, and is often associated with lichen planus, alopecia areata, and other dermatological conditions.

Clinical Presentation

Trachonychia presents with nails that appear rough and sandpaper-like. The nails may become thin and brittle, and in some cases, they may develop a "sandpaper" texture. The condition can affect all 20 nails, hence the name "twenty-nail dystrophy," but it can also present in fewer nails.

Etiology

The exact cause of trachonychia is not well understood, but it is often associated with autoimmune conditions such as lichen planus and alopecia areata. It is believed that an inflammatory process affects the nail matrix, leading to the characteristic changes in the nails.

Diagnosis

Diagnosis of trachonychia is primarily clinical, based on the appearance of the nails. A dermatologist may perform a nail biopsy to confirm the diagnosis and rule out other conditions. The biopsy typically shows spongiosis and a lichenoid tissue reaction in the nail matrix.

Management

There is no specific treatment for trachonychia, and management is often focused on treating any underlying conditions such as lichen planus or alopecia areata. In some cases, topical or intralesional corticosteroids may be used to reduce inflammation. The condition may resolve spontaneously over time.

See also

• Lichen planus
• Alopecia areata
• Nail anatomy
• Dermatology