ABSTRACT
The term trachyonychia refers to “rough nails.” It is a morphologic change with rough and thin nails with excessive longitudinal ridging as if nails have been rubbed with sand paper. The term twenty-nail dystrophy refers to trachyonychia affecting all the 20 nails. However, trachyonychia is a preferred terminology as all 20 nails may not be involved. It contributes to 1.5% of the population consulting for nail disorders, maximally affecting children in the age group of 3 to 12 years. Trachyonychia may be divided into two clinical subtypes: the most common opaque (rough-ridged nails) and less frequent shiny trachyonychia (uniform opalescent nails with fine pits). Though mostly idiopathic, trachyonychia may be associated with various dermatological and systemic diseases. Alopecia areata reportedly has the strongest association. The prognosis of trachyonychia is independent of the pattern of histology, hence biopsy is not essential. Histology, when performed, shows spongiosis and neutrophilic exocytosis in most of the cases. Trachyonychia is essentially a non-scarring condition so the prognosis is excellent, with spontaneous regression in nearly half of those affected. The conservative approach is hence the best approach. Evidence-based treatment is not defined, but multiple treatments have been tried ranging from topical steroids, retinoids, emollients, oral steroids, biotin, and cyclosporine to intramatriceal steroids.
