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Year : 2008  |  Volume : 74  |  Issue : 6  |  Page : 661-662

Segmental vitiligo and twenty-nail dystrophy: An unusual association

Department of Dermatology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Correspondence Address:
T S Rajashekar
Department of Dermatology, R. L. Jalappa Hospital and Research Centre, Tamaka, Kolar - 563 101, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0378-6323.45122

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How to cite this article:
Rajashekar T S, Singh G, Rajkumar V. Segmental vitiligo and twenty-nail dystrophy: An unusual association. Indian J Dermatol Venereol Leprol 2008;74:661-2

How to cite this URL:
Rajashekar T S, Singh G, Rajkumar V. Segmental vitiligo and twenty-nail dystrophy: An unusual association. Indian J Dermatol Venereol Leprol [serial online] 2008 [cited 2020 Jul 14];74:661-2. Available from:


Localized depigmented patches in a dermatomal distribution that do not cross the midline are called segmental vitiligo. The course of the segmental type tends to be earlier in onset and more stable than generalized vitiligo and is not familial. [1]

Twenty-nail dystrophy (TND) presents as rough surfaced nail plates and involving up to 20 nails. Two types of nail changes have been described. In the first type, the entire nail appears to have been sandpapered (sandpaper nails) in a longitudinal direction and shows excessive ridging and roughness. In the second type, the nail plate is shiny (shiny nails). [2] Here we report a case of an unusual association of segmental vitiligo and twenty-nail dystrophy.

A male patient aged 20 years presented with depigmented skin lesions since 5 years and also with nail changes of 2 years' duration.

On cutaneous examination, localized, multiple, round-to-oval-shaped, achromic macules were seen in a segmental distribution over the abdomen (corresponding to T9,10 dermatome). Examination of the nails revealed longitudinal ridging and roughness over the nail plates (sandpaper nails) in all the nails. Histopathology of an achromic macule showed marked absence of melanin granules, and Wood's lamp examination revealed amelanotic macules. Nail biopsy showed spongiosis in the nail matrix with mononuclear inflammatory infiltrate.

Association of cutaneous and systemic autoimmune diseases with vitiligo occurs more significantly in the non-segmental type than in the segmental type. [3] Though rarely, segmental vitiligo has been reported in association with a few skin disorders like poliosis, [1] halo nevus, [1],[3] nevoid basal cell carcinoma syndrome, [4]  Parry-Romberg syndrome More Details [5] and linear scleroderma. [6]

The association of vitiligo and TND is very rare and has been sparsely reported, [7],[8],[9],[10] and vitiligo in most of such associations was of non-segmental type, like generalized vitiligo, [7] scalp vitiligo (localized), [8] and acrofacial vitiligo.[9] However, association of segmental vitiligo with TND has been described in 2 patients. [10]

The association of segmental vitiligo with TND in the present case can be explained by the autoimmune origin of these disorders. Although the etiology of segmental vitiligo is based primarily on the neurogenic theory of melanocyte destruction, an immune mechanism cannot be completely ruled out, because autoimmune disorders have been described in approximately 3.4% to 9.5% of cases of segmental vitiligo. [1],[11] Further, systemic and topical steroids and psoralen with ultraviolet A (PUVA) therapy have shown encouraging responses in early lesions. [11] The strong association of TND with dermatoses which have autoimmune etiopathogenesis has led some to speculate that the nail changes are primarily due to an autoimmune process. [12],[13] Thus our case emphasizes a common autoimmune insult to the melanocytes and nail matrix as the logical explanation for this rare association.

  References Top

1.Hann SK, Lee HJ. Segmental vitiligo: Clinical findings in 208 patients. J Am Acad Dermatol 1996;35:671-4.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Buran R. Twenty nail dystrophy of alopecia areata. Arch Dermatol 1981;117:1.  Back to cited text no. 2    
3.Koga M, Tango T. Clinical features and course of type A and type B vitiligo. Br J Dermatol 1988;118:223-8.  Back to cited text no. 3  [PUBMED]  
4.Muramatsu S, Suga Y, Mizuno Y, Haseeqawa T, Komuro S, Kubo Y, et al . A Japanese case of naevoid basal cell carcinoma syndrome associated with segmental vitiligo. Br J Dermatol 2005;152:812-4.  Back to cited text no. 4    
5.Creus L, Sanchez-Regana M, Salleras M, Chaussade V, Umbert P. Parry-Romberg syndrome associated with homolateral segmental vitiligo. Ann Dermatol Venereol 1994;121:710-1.  Back to cited text no. 5    
6.Bonifati C, Impara G, Morrone A, Pietrangeli A, Carducci M. Simultaneous occurrence of linear scleroderma and homolateral segmental vitiligo. J Eur Acad Dermatol Venereol 2006;20:63-5.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Barth JH, Telfer NR, Dawber RP. Nail abnormalities and autoimmunity. J Am Acad Dermatol 1988;18:1062-5.  Back to cited text no. 7  [PUBMED]  
8.Peloro TM, Pride HB. Twenty-nail dystrophy and vitiligo: A rare association. J Am Acad Dermatol 1999;40:488-90.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Khandpur S, Bansal A, Sharma VK, Bhatti SS, Singh MK. Twenty-nail dystrophy in vitiligo. J Dermatol 2007;34:189-92.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Khandpur S, Reddy BS. An association of Twenty-nail dystrophy with vitiligo. J Dermatol 2001;28:38-42.  Back to cited text no. 10  [PUBMED]  
11.Park KC, Youn JI, Lee YS. Clinical study of 326 cases of vitiligo. Korean J Dermatol 1988;26:200-5.  Back to cited text no. 11    
12.Baran R, Dawber R. Twenty-nail dystrophy of childhood: A misnamed syndrome. Cutis 1987;39:481-2.  Back to cited text no. 12  [PUBMED]  
13.Scher RK, Fischbein R, Ackerman AB. Twenty-nail dystrophy: A variant of lichen planus. Arch Dermatol 1978;114:612-3.  Back to cited text no. 13  [PUBMED]  

This article has been cited by
1 Clinical study of nail changes in vitiligo
Tag Anbar,Rania Abdel Hay,Amal T Abdel-Rahman,Noha H Moftah,Mohamed A Al-Khayyat
Journal of Cosmetic Dermatology. 2013; 12(1): 67
[Pubmed] | [DOI]
2 First histopathological and immunophenotypic analysis of early dynamic events in a patient with segmental vitiligo associated with halo nevi : Histopathological and immunophenotypic analysis in a patient with segmental vitiligo
Nanja A. C. Van Geel, Ilse G. Mollet, Sofie De Schepper, Esther P. M. Tjin, Karim Vermaelen, Rachael A. Clark, Thomas S. Kupper, Rosalie M. Luiten, Jo Lambert
Pigment Cell & Melanoma Research. 2010; 23(3): 375
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