Twenty-nail dystrophy (TND), also known as trachyonychia, is a nail disorder that can change the look and feel of one or more of your fingernails and toenails. The name suggests all twenty nails are always involved, but that’s not always the case.
Getting an accurate diagnosis is important because TND can look like other nail conditions. Also, when a person experiences widespread nail problems, it can be easy to misdiagnose trachyonychia, leading to treatments that aren’t helpful or that delay the management of any underlying conditions that could be contributing to the nail changes.
To help you learn more about this condition, this article will offer a comprehensive overview of TND, including:
- how it appears
- conditions that may be associated with it
- how it’s different from other conditions
- treatment options
We’ll also highlight the importance of getting the right diagnosis through a careful physical exam and consideration of any related health issues.
So, if you’re looking for 20-nail dystrophy pictures and information, keep reading.
What is trachyonychia?
Trachyonychia, sometimes called 20-nail dystrophy, is a condition that affects the fingernails and toenails. It causes changes in the texture and appearance of the nails, making them rough and brittle.
The term “trachyonychia” comes from Greek words that mean “rough nail.”
It’s worth noting that even though the name “20-nail dystrophy” implies that all 20 nails are affected, that’s not always the case. Sometimes just a few nails are involved.
Characteristics of trachyonychia
Here are some common features of trachyonychia:
- Sandpaper nails: The surface of the nail often feels rough, like sandpaper.
- Nail plate changes: The nails may look brittle, thin, and dull. They often have ridges that run lengthwise along the nail. You may also see pits or depressions in the nail surface.
- Color changes: The nail plate can change color, sometimes appearing grayish or yellowish.
Because these symptoms can also be signs of other conditions, it’s best to consult with your doctor if you think you have trachyonychia.
Clinical presentation
When doctors examine someone with suspected 20-nail dystrophy, they look for certain nail characteristics.
Nail Morphology
Here’s what doctors look for when they examine the nails of someone with 20-nail dystrophy.
Longitudinal Ridging
A key sign of trachyonychia is prominent longitudinal ridges. These ridges can be fine or coarse, and they may differ in depth and prominence.
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Pitting
There may be small, pinpoint depressions (pits) on the surface of the nail.
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Onychoschizia and Onychorrhexis
Brittle nails may show onychoschizia (splitting of the nail plate) and onychorrhexis (longitudinal splitting or ridging).
Koilonychia
In some cases, the nails may become spoon-shaped (koilonychia).
Number of Nails Affected
One of the key features of 20-nail dystrophy is that it can affect any number of nails.
Variable Involvement
Trachyonychia can affect one nail, several nails, or all 20 nails.
Pattern of Involvement
The pattern of nail involvement can vary. Some patients have symmetrical involvement of all nails, while others have more localized or asymmetrical changes.
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Symptoms
The symptoms of 20-nail dystrophy can vary.
Cosmetic Concerns
Many patients want treatment for cosmetic reasons because they don’t like the way their nails look.
Functional Impairment
In severe cases, nail dystrophy can cause pain or make it hard to perform fine motor tasks.
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Disease associations
Sometimes, but not always, 20-nail dystrophy can be a sign of another health condition.
Skin diseases
Alopecia areata
Trachyonychia is often connected to alopecia areata, which is an autoimmune condition that causes hair loss. Research suggests that about 4 out of 100 people with alopecia areata also have trachyonychia.
Psoriasis
Trachyonychia can be a sign of psoriasis, a long-term inflammatory condition that affects the skin. When psoriasis causes trachyonychia, people may also have other nail changes, like pitting, onycholysis (when the nail separates from the nail bed), and thickening under the nail.
Lichen planus
Nail lichen planus, a long-term inflammatory condition of the skin and mucous membranes, can also lead to trachyonychia. One study showed that 2 out of 15 children with nail lichen planus had trachyonychia.
Systemic diseases
Amyloidosis
Trachyonychia has been connected to amyloidosis, a rare condition where abnormal proteins build up in tissues and organs.
Idiopathic trachyonychia
No underlying cause
Sometimes, trachyonychia happens without any clear reason. This is called idiopathic trachyonychia.
Spontaneous improvement
Often, the condition gets better on its own, especially in idiopathic cases and when it starts in childhood.
What else could it be?
It’s important to get a careful clinical exam to find out whether your nail changes are caused by 20-nail dystrophy or something else. Your doctor will look for specific features, such as pitting, longitudinal ridging, and other changes to the nail plate.
Here are some other conditions that can look like 20-nail dystrophy:
Psoriasis
Psoriasis can affect the nails in ways that look like 20-nail dystrophy. But with psoriasis, you may also see oil spots under the nails or onycholysis. Onycholysis is when the nail separates from the nail bed.
Lichen planus
Nail lichen planus can also cause nail changes similar to those seen in 20-nail dystrophy. It can also cause scarring and pterygium formation. A pterygium is a triangular piece of skin that grows onto the nail plate.
Eczema
If you have chronic eczema on your fingers, that can lead to nail changes that look a lot like 20-nail dystrophy.
Onychomycosis
Onychomycosis is a fungal infection of the nail. It can cause the nails to thicken and become deformed, which can look like 20-nail dystrophy. For severe cases of nail fungus, some explore treatments such as EMUAID.
Do I need a nail biopsy?
Usually, a nail biopsy isn’t needed to diagnose 20-nail dystrophy. A diagnosis can usually be made based on a clinical exam.
Treatment Options
Because 20-nail dystrophy can be related to several underlying conditions, there is no one-size-fits-all treatment. It may take time and the attention of a good dermatologist to figure out what will help you.
Conservative management
Here are some simple steps you can take at home.
- Emollients. When you moisturize your hands and feet, be sure to rub some into your nail beds. Hydrating the nail plate can improve its appearance and make it more flexible.
- Nail polish. While it won’t treat the underlying cause, nail polish can hide the nail changes that come with 20-nail dystrophy and protect the nails from further damage. It’s important to take risks and precautions when getting pedicures.
Topical therapies
Here are some medications a dermatologist might prescribe.
- Corticosteroids. Applied directly to the nails, topical corticosteroids can reduce inflammation and improve nail growth, in some cases.
- Tazarotene. This topical retinoid may also be effective in treating 20-nail dystrophy.
- Calcipotriol/Betamethasone Dipropionate. One study showed a whopping 98.6% of nails got better after six months of treatment with this ointment.
Systemic therapies
These are medications or supplements you take orally.
- Biotin. This supplement may improve nail strength and growth.
- Systemic corticosteroids. In severe cases of 20-nail dystrophy caused by an underlying inflammatory condition, a doctor might prescribe this medication.
- Other systemic agents. Some people have had success treating 20-nail dystrophy with cyclosporine, retinoids, and tofacitinib.
Spontaneous resolution
One of the most hopeful things about 20-nail dystrophy is that it often improves on its own!
Spontaneous improvement is most common in cases that don’t have an identifiable cause and in cases that start in childhood.
One study reported that half the patients in the study experienced a resolution of symptoms or saw considerable improvement within six years, regardless of the treatment they tried.
Frequently Asked Questions
What does nail dystrophy look like?
Nail dystrophy, in general, presents with a variety of changes to the nails. You might see thickened nails, changes in nail shape (like curving or spooning), discoloration (yellowing, browning, or whitening), pitting (small depressions on the nail surface), or ridges running along the nail. In severe cases, the nail may separate from the nail bed (onycholysis) or crumble. Because “nail dystrophy” is a broad term, the exact appearance can vary greatly.
Is 20-nail dystrophy an autoimmune disease?
20-nail dystrophy isn’t always an autoimmune disease, but it can be associated with several autoimmune conditions, particularly lichen planus and alopecia areata. In some cases, the cause is unknown (idiopathic). When it occurs alongside an autoimmune condition, it’s thought that the autoimmune process affects the nail matrix, leading to the characteristic nail changes.
Is 20-nail dystrophy rare?
While not extremely common, 20-nail dystrophy isn’t considered a truly rare condition. It’s more frequently seen in children, but adults can also develop it. Because nail changes can have many causes, it’s important to consult a dermatologist for proper diagnosis and management if you suspect you have 20-nail dystrophy or any other nail disorder. Sometimes, the condition resolves on its own, especially in children.
Conclusion
Trachyonychia, or 20-nail dystrophy, is a diagnosis that a doctor has to make by carefully examining your nails and considering if you have any other related health conditions.
It’s important to make sure that trachyonychia is not confused with other nail problems that can look similar. Getting the right diagnosis is essential for getting the right treatment.
Treatments for trachyonychia vary depending on how severe the condition is and if you have any underlying health problems. Options range from simply taking care of your nails to using topical or even systemic medications.
Sometimes trachyonychia goes away on its own, and sometimes it needs long-term treatment. It’s hard to know which way it will go.
Because trachyonychia can be difficult to treat, more research is needed to find better and more reliable ways to manage it. If you think you may have trachyonychia, see a doctor for an accurate diagnosis and to discuss your treatment options.