|LETTER TO EDITOR
|Year : 1994 | Volume
| Issue : 6 | Page : 372-373
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishna K. Twenty-nail dystrophy. Indian J Dermatol Venereol Leprol 1994;60:372-3
To the Editor,
A 20-year-male, dental student, presented with asymptomatic disfigurement of all 20 nails since age of 8 years. Onset was over the thumb and great toe nails, with gradual involvement of all the remaining nails within a period of one year. Nails were opalescent and dull with loss of nail lustre. They were thin and fragile, and had closely-set longitudinal striations.
The second case was a 28-year-female farmer who presented with thickened, brown and irregular nails of 22 years duration. Onset was simultaneous over all finger and toe nails. There was loss of nail lustre, longitudinal striations and onycholysis.
Similar nail chages in family members; or any evidence of lichen planus, psoriasis or alopecia areata was not found in both of the above patients. Nail clipping for KOH preparation and culture was consistently negative.
Hazelrigg et al, in 1977, proposed the term "twenty-nail dystrophy" for onychodystrophy of all 20 nails without antecedent disease. Its causes include lichen planus, alopecia areata, psoriasis, other inflammatory dermatoses or it may be idiopathic.  Other rarer causes are ichthyosis vulgaris, selective IgA deficiency, familial severe cases and ectodermal dysplasias. 
Twenty-nail dystrophy is an idiopathic nail dystrophy which begins insidiously and asymptomatically in early childhood (18 months to 12 years).  Onset may occur simultaneously in all the nails or in individual nails gradually over many months .  It is self limited and resolves slowly with age . 
Both of my cases of idiopathic tewentynail dystrophy had onset in childhood, consistent with earlier findings .  However, there was no evidence of resolution of nail chages in either patients.
| References|| |
|1.||Horn RT Jr, Odom RM. Twenty-nail dystrophy of alopecia areata. Arch Dermatol 1980; 116 573-4. |
|2.||Baran R, Dawber RPR. The nail in childhood and old age. In : Diseases of the nails and their management (Baran R, Dawber RPR, eds). Oxford : Blackwell Scientific Publications, 1984 : 105-20. |
|3.||Hazelrigg DE, Duncan WD, Jarrett M. Twentynail dystrophy of Childhood. Arch Dermatol. 1977; 113 :73-5. |
|4.||Silverman RA. Paediatric disease. In : Nails Therapy, Diagnosis, Surgery (Scher RK, Daniel CR, eds). Philadelphia : WB Saunders, 1990; 82-105. |