Trachyonychia


Trachyonychia

Description, Causes and Risk Factors:

Trachyonychia or rough nails, may present as an idiopathic disorder of the nails or it can be associated with other dermatological conditions. Two clinical varieties of trachyonychia: a severe type, characterized by opaque, sandpaper nails, and a mild type characterized by shiny nails with superficial riding and diffuse pitting.

The exact cause of trachyonychia is unknown. Most cases occur by chance without any other symptoms. In some cases, trachyonychia has been diagnosed in individuals who also have another skin condition such as alopecia areata, eczema, or psoriasis; this has led some physicians to question whether the skin condition causes trachyonychia in those individuals.

There is a recognized association between hair loss and trachyonychia, but it is not known if one condition causes the other. Individuals with trachyonychia often also have hair loss, though the extent of hair loss varies from mild to severe. In severe cases of hair loss, the individual may have a condition called alopecia areata.

The disease has been reported to be transmitted in an autosomal dominant fashion in some families. Idiopathic trachyonychia is likely to be much more common than it is traditionally reported in the literature, as only a few isolated reports of idiopathic trachyonychia have been documented. Determining the causes of trachyonychia when other clinical features are not present can be challenging.

Forty of 1095 patients (3.65%) with alopecia areata had severe nail changes that fulfilled the clinical criteria for the diagnosis of trachyonychia. Twelve of these patients had a nail biopsy. A mild-to-moderately dense lymphocytic infiltrate associated with exocytosis and spongiosis was detected in the proximal nailfold, nail matrix, nail bed, and hyponychium of 11 patients. One patient showed the pathologic changes of lichen planus; lichen planus of the skin developed 6 months after the nail biopsy. Immunohistochemical characterization on paraffin- embedded sections showed that the inflammatory infiltrate consisted of peripheral T lymphocytes. Immunophenotyping on frozen sections was performed in four cases. The results revealed a T4/T8 ratio of 2:1 and the presence of Langerhans cells in the nail matrix. Our results show that trachyonychia is an uncommon nail manifestation of alopecia areata. Distinctive pathologic features of mild-to-moderately dense lymphocytic infiltrate associated with exocytosis and spongiosis characterize trachyonychia as well as the other nail abnormalities caused by alopecia areata. The clinical association of trachyonychia with alopecia areata does not exclude that the nail abnormality can be due to other diseases such as lichen planus.

Symptoms:

The nail shows diffuse ridging with lack of luster, and in severe cases sandpaper-like surface. In some, the nail plate abnormality may be less severe and one can see numerous, small superficial pits, which impart a shiny appearance to the surface of the nail.

Diagnosis:

The condition is well-recognized and its diagnosis is made on the basis of clinical features characterized by onset in infancy/childhood, and occasionally in adults. The lesions are fairly representative, and are characterized by the alternating elevation and depression (ridging) and/or pitting, lack of luster, roughening likened to sandpaper, splitting, and change to a muddy grayish-white color.

The pathological diagnosis requires a nail matrix punch or longitudinal nail biopsy. However, the pathological diagnosis of trachyonychia is not really required as the disease has a benign outcome, even when caused by lichen planus.

The most common histopathologic features associated with trachyonychia are spongiosis and exocytosis of inflammatory cells into the nail epithelia; typical features of lichen planus or psoriasis can also be detected.

Treatment:

The various treatment modalities for trachyonychia often target the underlying disorder such as AA, LP, or psoriasis. It is important to note that trachyonychia may be self-limiting in many cases and as such treatments should only be given when deemed essential. Furthermore, injections into the nail matrix should rarely be considered. When intervention is necessary, results are often unsatisfactory. Some treatments that have been advocated include oral antifungal, systemic corticosteroids, tazarotene, and topical PUVA (psoralen (P) and ultraviolet A (UVA) therapy). Unfortunately, treatment of the associated skin disease usually has no effect on the ridging and roughness of the nails.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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