Have you ever noticed changes in the texture or appearance of your fingernails or toenails? Maybe they’ve become rough, ridged, or discolored. These changes could be signs of a condition called trachyonychia.
Trachyonychia, also known as twenty-nail dystrophy, is a nail disorder that affects the nail plates. Despite its alternative name, it can affect just one nail or many, but not necessarily all twenty.
Trachyonychia can be a condition all its own, or it can be related to other skin or systemic diseases. This means that proper diagnosis is essential for determining the best course of treatment.
While often harmless, trachyonychia can cause cosmetic concerns and discomfort, impacting a person’s quality of life; a medical pedicure can address related foot health issues. For this reason, it’s important to understand what trachyonychia is, what causes it, how it’s diagnosed, and what treatment options are available.
This article will cover everything you need to know about trachyonychia, including its definition, causes, symptoms, diagnosis, and treatment options. We’ll also emphasize the importance of getting an accurate diagnosis to ensure you receive the most appropriate care.
What is trachyonychia?
Trachyonychia is a condition that affects the fingernails and toenails, causing changes in their appearance and texture.
What it looks like
If you have trachyonychia, your nails will likely have:
- Rough surfaces
- Ridges that run lengthwise
- A texture a bit like sandpaper
- A brittle, thin consistency
Using a tool called an onychoscope, a doctor can also see signs of trachyonychia, such as:
- A yellowish tint
- Flaky scales
- Ridges that run lengthwise
How it’s different from other nail problems
It’s important to tell trachyonychia apart from other conditions that cause changes in your nails, such as onychorrhexis (longitudinal ridging of the nails) and onychoschizia (splitting of the nails).
Twenty-Nail Dystrophy (TND)
In the past, trachyonychia was often called Twenty-Nail Dystrophy, but it’s important to know that trachyonychia can affect fewer than 20 nails.
Types of trachyonychia
There are two main types of trachyonychia: opaque and shiny. Opaque trachyonychia is more common and tends to be more severe.
What causes trachyonychia?
Sometimes, the causes of trachyonychia are mysterious.
Idiopathic trachyonychia
In many cases, health professionals can’t identify a clear cause for the condition. When there’s no known cause, it’s called idiopathic trachyonychia. This is more common in children, usually starting between the ages of 3 and 12. The good news is that in children, idiopathic trachyonychia often goes away on its own.
Conditions associated with trachyonychia
Trachyonychia is sometimes associated with other health conditions. These can include:
- Alopecia areata. This is an autoimmune condition that causes hair loss. Studies show that trachyonychia is present in about 3.65% of people with alopecia areata.
- Psoriasis. This is a skin condition that causes thick, scaly patches on the skin.
- Lichen planus. This inflammatory condition can affect the skin, mouth, and nails. Nail lichen planus can lead to trachyonychia in some cases.
- Atopic dermatitis (eczema). This is a condition that causes itchy, inflamed skin.
- Vitiligo. This is a condition that causes loss of pigment in the skin, resulting in white patches.
Rarely, trachyonychia is associated with systemic diseases like juvenile dermatomyositis and myeloma-associated amyloidosis.
The role of inflammation
Scientists don’t yet fully understand the underlying causes of trachyonychia. However, they believe that inflammation affecting the nail matrix (where the nail grows from) plays a significant role.
How does trachyonychia show up?
The symptoms of trachyonychia can vary quite a bit, and they may not be the same for everyone. Here’s a breakdown of the most common things you might notice:
Nail plate changes
The nail plate is the hard, visible part of your nail, and trachyonychia can really change how it looks and feels.
- Surface abnormalities: The most noticeable sign is a rough nail surface. It’s often covered in longitudinal ridges (lines running from the cuticle to the tip), which give it a sandpaper-like texture.
- Nail thickness and brittleness: Trachyonychia can cause your nails to become thin and brittle, making them prone to splitting (onychoschizia) or breaking (onychorrhexis).
- Color changes: Many people with trachyonychia notice a yellowish tint to their nails.
Nail bed and cuticle involvement
Changes around the base of the nail can also be a sign of this condition.
- Cuticular changes: The cuticle (the skin at the base of your nail) might look ragged, inflamed, or overgrown.
- Splinter hemorrhages: You might see small, dark lines under the nail, which look like splinters. These are actually tiny areas of bleeding.
Number of nails affected
The number of nails affected by trachyonychia can vary widely.
- Variable presentation: It could be just one nail, or it could be all twenty (both fingernails and toenails).
- Distribution patterns: If more than one nail is affected, the pattern of distribution can sometimes give clues as to what’s causing the condition. For instance, if all the nails on one hand are affected, it might suggest a localized issue.
Diagnosis and evaluation
If you think you might have trachyonychia, a healthcare professional can help you get a diagnosis and explore treatment options.
Clinical examination
To start, your doctor will ask questions about your health history and symptoms and give you a physical exam.
They’ll ask questions to find out if you have any underlying conditions or triggers that might be the cause of your nail problems.
During the physical exam, they’ll examine your nails, skin, and other body systems to get a better understanding of your overall health.
Onychoscopy
Onychoscopy is a non-invasive test that lets doctors examine the structure of your nails closely.
When doctors use onychoscopy to look at nails affected by trachyonychia, they often see:
- yellowish discoloration
- scales
- long ridges
- splinter hemorrhages (tiny lines of blood under the nail)
Nail biopsy
A nail biopsy is generally not needed, because trachyonychia is benign and often resolves on its own. But if your case is complex or your doctor isn’t sure what’s going on, they might recommend a nail biopsy.
During a nail biopsy, the doctor removes a small piece of your nail and sends it to a lab to be examined under a microscope to identify fungi by picture, among other things.
If the lab finds trachyonychia, they may see:
- spongiosis (swelling in the nail)
- inflammatory cells
- a collection of lymphocytes (a type of white blood cell)
What else could it be?
Several conditions can look like trachyonychia, so it’s important to get the right diagnosis. Here are some of the conditions that can mimic trachyonychia:
Psoriasis
Psoriasis in the nails can cause pitting, separation of the nail from the nail bed (onycholysis), and thickening under the nail (subungual hyperkeratosis). Sometimes these symptoms look like trachyonychia.
Lichen planus
Lichen planus can affect the nails, causing them to get thin, develop ridges, and form pterygium (scarring of the nail fold that extends onto the nail bed).
Eczema/dermatitis
Eczema or dermatitis can affect the skin around the nails, leading to nail problems (dystrophy).
Alopecia areata
Alopecia areata is known to cause trachyonychia. But it can also cause other changes in the nails, such as pitting and Beau’s lines (horizontal grooves in the nail).
Why getting the right diagnosis matters
Getting an accurate diagnosis is important so that you can get the right treatment and manage the condition properly. You want to avoid being misdiagnosed.
How is trachyonychia treated?
There’s no single best way to treat trachyonychia, and in many cases, treatment isn’t necessary.
If your doctor can identify an underlying condition, treating that condition will be the first step.
Often, treatment is for cosmetic purposes. Trachyonychia isn’t a scarring condition, and your nails will likely return to their typical appearance over time.
If your child has trachyonychia with no known cause, your doctor may simply suggest keeping an eye on it and offering reassurance. In many cases, the condition improves on its own.
If you do want to try to improve the appearance of the nails, several options are available.
Topical therapies
Creams and ointments that you apply directly to the nails are often the first choice for treatment.
- Corticosteroids. Topical corticosteroids, like clobetasol propionate, can be applied and then covered with a bandage or dressing to help them absorb.
- Calcipotriol/betamethasone. Calcipotriol/betamethasone dipropionate ointment has looked promising in some studies.
- Other topicals. Other options include tazarotene and 5-fluorouracil. Keep in mind that thickened nail plates can make it harder for topical medications to penetrate.
Systemic therapies
If topical treatments aren’t enough, your doctor may suggest medications that work throughout your body. These medications can have significant side effects, so they’re usually reserved for severe cases.
- Systemic corticosteroids. Systemic corticosteroids may be considered in severe cases.
- Other systemic agents. Other options include cyclosporine, retinoids, methotrexate, and tofacitinib.
Newer treatment methods
Researchers are always looking for new and better ways to treat skin and nail conditions.
- Emerging therapies. Newer treatments such as fractional CO2 laser and alitretinoin show promise.
Frequently Asked Questions
Is there a cure for trachyonychia?
Unfortunately, there isn’t a definitive “cure” for trachyonychia that works for everyone. Treatment often focuses on managing the symptoms and underlying causes. In some cases, the condition may resolve on its own over time, especially in children. Treatments can include topical corticosteroids, calcipotriol cream, or, in more severe cases, injections of corticosteroids into the nail matrix. The best approach depends on the severity and any associated conditions, so it’s crucial to consult a dermatologist.
What is the difference between onychorrhexis and trachyonychia?
While both onychorrhexis and trachyonychia affect the nails, they present differently. Onychrrhexis refers to longitudinal ridging and splitting of the nails, making them brittle and prone to breakage. Trachyonychia, on the other hand, causes rough, sandpaper-like nails with tiny pits or grooves, often described as “sandpaper nails.” Think of onychrrhexis as brittle, splitting nails, and trachyonychia as rough, textured nails.
What drugs cause trachyonychia?
Drug-induced trachyonychia is relatively rare, but certain medications have been linked to the condition. Some possible culprits include gold salts (used to treat rheumatoid arthritis), retinoids (like acitretin), and certain chemotherapy drugs. If you develop trachyonychia while taking a new medication, it’s important to discuss this with your doctor. They can evaluate whether the drug might be a contributing factor and explore alternative treatment options.
In Closing
Trachyonychia is a nail disorder that causes nails to become rough and misshapen. It can be caused by a number of things, ranging from unknown (idiopathic) causes to underlying health conditions.
It’s important to get a correct diagnosis to be sure that you have trachyonychia and not some other nail disorder, and to figure out if it is related to an underlying cause.
More research is needed to understand exactly what causes trachyonychia and to develop better ways to treat it. Treatments exist that can help with the symptoms of trachyonychia, but there is not yet a cure.