DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194759

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

Harshitha Shanmuganathan, Radha Kumar

Abstract


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.


Keywords


Benign, Brittle nails, Children, Self-limiting, Trachyonychia, Twenty nail dystrophy

Full Text:

PDF

References


Tosti A, Bardazzi F, Piraccini BM, Fanti PA. Idiopathic trachyonychia (twenty‐nail dystrophy): a pathological study of 23 patients. Br J Dermatol. 1994 Dec;131(6):866-72.

Bolognia J, Jorizzo JL, Schaffer JV. Dermatology. 3rd Ed. Philadelphia: Elsevier Saunders, 2012.

Sehgal VN. Twenty nail dystrophy trachyonychia: an overview. J dermatol. 2007 Jun;34(6):361-6.

Ohta Y, Katsuoka K. A case report of twenty nail dystrophy. J Dermatol. 1997;24:60-2.

Scheinfeld NS. Trachyonychia: a case report and review of manifestations, associations, and treatments. Cutis. 2003 Apr;71(4):299-302.

Dehesa L, Tosti A. Treatment of inflammatory nail disorders. Dermatol Ther. 2012;25(6):525-34.

Baran R, Richert B. Physical signs. In: Baran R, de Berker D, Haneke E, Tosti A, eds. Diseases of the nails and their management. 3rd ed. London: Blackwell Science; 2001: 67-69.

Sakata S, Howard A, Tosti A, Sinclair R. Follow up of 12 patients with trachyonychia. Australas J Dermatol. 2006 Aug;47(3):166-8.

Taniguchi S, Kutsuna H, Tani Y, Kawahira K, Hamada T. Twenty-nail dystrophy (trachyonychia) caused by lichen planus in a patient with alopecia universalis and ichthyosis vulgaris. J Am Acad Dermatol. 1995 Nov 1;33(5):903-5.

Kanwar AJ, Ghosh S, Thami GP, Kaur S. Twenty‐nail dystrophy due to lichen planus in a patient with alopecia areata. Clini Exper Dermatol. 1993 May;18(3):293-4.

Scher RK, Fischbein R, Ackerman AB. Twenty-nail dystrophy: A variant of lichen planus. Arch Dermatol. 1978 Apr 1;114(4):612-3.

Silverman RA, Rhodes AR. Twenty‐nail dystrophy of childhood: a sign of localized lichen planus. Pediatr Dermatol. 1984 Jan;1(3):207-10.

Commens CA. Twenty nail dystrophy in identical twins. Pediatr Dermatol. 1988 May;5(2):117-9.

Sehgal VN. Twenty nail dystrophy trachyonychia: an overview. J Dermatol. 2007 Jun;34(6):361-6.

Ohta Y, Katsuoka K. A case report of twenty‐nail dystrophy. J Dermatol. 1997 Jan;24(1):60-2.

Chu DH, Rubin AI. Diagnosis and management of nail disorders in children. Pediatr Clini. 2014 Apr 1;61(2):293-308.