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SUMMARY
Twenty-nail dystrophy is commonly used synonymously with trachyonychia.
There are two varieties of trachyonychia: opaque and shiny.
It is commonly associated with alopecia areata; it can be a symptom of nail lichen planus, psoriasis, or eczema.
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TIPS FOR TREATMENT
Treatment often is prescribed for cosmetic reasons due to its non-scarring course.
Topical therapies should be tried initially, followed by intra-matricial steroid injections and systemic options in the end.
Systemic medications are only indicated when it is associated with other conditions.
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DON’T FORGET
Opaque variety is more severe with thin and brittle nails with excessive longitudinal ridging, whereas the shiny variety has superficial ridging with small geometric pits.
Patient should be counseled about its benign nature and good prognosis.
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PATIENT EDUCATION POINTS
Reassurance is the best option for mild cases, since it resolves spontaneously at times.
It has a benign course and should not be very worried about the disease.
Treatment is often prescribed for solely cosmetic appearance.
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Trachyonychia, is derived from the Greek word “trakos,” meaning rough. It signifies thin, rough, brittle nails comprising of extensive longitudinal ridging.1 Earlier it was labeled as twenty-nail dystrophy, which is quite misleading because it does not necessarily involve all the nails. It can affect one to all nails (Fig. 7.1).
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Trachyonychia is more commonly seen in children with a peak age of onset between 3 and 12 years of age.2 Trachyonychia can occur in association with alopecia areata, be a sign of lichen planus or psoriasis, or it can be idiopathic.2,3
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A careful and detailed history is very important to make a diagnosis of trachyonychia. Since it is associated with various conditions, it becomes mandatory to look for signs of those conditions and also to take history pertinent to them. Various dermatological and non-dermatological associations are elaborated in Table 7.1.4
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