By Gary M. White, MD
Trachyonychia is descriptive term used to describe the nails when they are rough and lack luster. It mimics a nail infection, but is not. The cause may be unknown, or associated with alopecia areata, lichen planus, or psoriasis. Children are typically affected. When all 20 nails are involved, the term 20 nail dystrophy is used.
One or multiple nails are rough and lacking in luster. Longitudinal striations, ridges, fissures, or pitting may be present. A fungal culture should be done if the diagnosis is in doubt. A complete skin examination is recommended to exclude cutaneous signs of alopecia areata, psoriasis, lichen planus, vitiligo, and incontinentia pigmenti, etc. In addition, one should make sure there is no inflammation of the skin about the nails as that can cause a chronic nail dystrophy (see chronic paronychia).
No treatment is uniformly helpful in idiopathic cases. Improvement occurs in the majority over time and even spontaneous remission may occur [Ped Derm 2015;32;198]. Rarely patients with isolated trachyonychia can later develop psoriasis or alopecia areata.
Lackluster nails and pterygium (scarring between the proximal nailfold and the nail matrix) associated with lichen planus.
Nail pitting associated with alopecia areata.
Trachyonychia from lichen planus. Acta Dermato-Venereologica 2015;95;372
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