Trachyonychia and Twenty-Nail Dystrophy: A Comprehensive Review and Discussion of Diagnostic Accuracy

Abstract

Background/Aims: The term trachyonychia, also known as twenty-nail dystrophy, is used to describe thin, brittle nails with excessive longitudinal ridging. The term twenty-nail dystrophy has been incorrectly applied to other conditions that can affect all twenty nails. Therefore, we have conducted a comprehensive review of the clinical features of trachyonychia and have included a discussion regarding the diagnostic accuracy of this condition in the literature. Methods: In November and December 2015, we conducted a thorough literature search using the following search terms: ‘trachyonychia', ‘twenty nail dystrophy', and ‘sandpaper nails'. Articles that reported the epidemiology, disease associations, clinical presentation, histopathology, and treatment options for trachyonychia were included. Particular attention was given to case reports to identify misdiagnosed cases of twenty-nail dystrophy. Results: Our preliminary search yielded 184 results with 72 unique articles ultimately selected for review. Excluded articles included 27 articles in languages other than English, 18 commentaries or reviews, and 67 irrelevant articles. Twelve additional articles described nail abnormalities clinically different from trachyonychia. Conclusion: Many other conditions can cause widespread nail dystrophy. The specific characteristics of trachyonychia need to be considered to make the diagnosis of twenty-nail dystrophy.

Paediatric nail consultation in an academic centre in Belgium: a 10‐year retrospective study

“…Trachyonychia, which is a diagnosis made clinically, was mainly observed in the [6 to <12 years old] age group. Biopsies for diagnostic purposes are not recommended because whatever the diagnosis, trachyonychia does not lead to nail destruction . Annual follow‐up is usually suggested to reassure parents and their child.…”

“…Annual follow‐up is usually suggested to reassure parents and their child. Our study found improvement or cure in 75% of cases, confirming the good prognosis previously published, regardless of treatment . Park et al .…”

Trachyonychia: a retrospective study of 122 patients in a period of 30 years

“…This condition was first described by Alkiewicz in 1950 while Hazelrigg et al . in 1977 observed a subtype of trachyonychia, which they called twenty‐nail dystrophy, where all twenty nails and toenails were uniformly affected; however, it is important to underline that trachyonychia can involve any number of nails and the term twenty‐nail dystrophy is quite aspecific because there are multiple conditions which can affect all twenty nails, aside from trachyonychia.…”

Onychoscopy of trachyonychia: an analysis of 30 patients and comparison with onychomycosis

“…Dear Editor , The diagnosis of trachyonychia is often challenging, and misdiagnoses, particularly as onychomycosis, are common . The correct diagnosis of trachyonychia is crucial because treatment options for trachyonychia include observation or active nonintervention, topical and systemic steroids, or immunomodulating agents, while onychomycosis should be treated with antifungal agents . Onychoscopy (nail dermoscopy) is a useful tool for various nail disorders .…”