Twenty-nail dystrophy

Question Question

A dermatologist recently advised that I have twenty-nail dystrophy. However, when I read about this, it is described as a childhood disorder. Only as an adult have my nails become brittle, with ridges vertical and horizontal. This has even affected my toenails. Also, I am losing a lot of hair. What causes twenty-nail dystrophy?

Answer Answer

The following information may help to address your question:

Can twenty-nail dystrophy affect adults?
What causes twenty-nail dystrophy?
Can twenty-nail dystrophy cause hair loss?

Can twenty-nail dystrophy affect adults?

Although the symptoms of twenty-nail dystrophy usually begin in childhood, adults can also be affected by this condition.^[1] One article in the medical literature describes a woman who first showed symptoms of this condition at age 21.^[2] Another article describes an individual who was 63 when he first developed symptoms in his fingernails, but his toenails were not affected. He was diagnosed with tachyonychia, and twenty-nail dystrophy is thought to be a type of tachyonychia.^[3]

Last updated: 7/4/2012

What causes twenty-nail dystrophy?

The exact cause of twenty-nail dystrophy is unknown. Most cases occur by chance without any other symptoms. In some cases, twenty-nail dystrophy has been diagnosed in individuals who also have another skin condition such as alopecia areata, eczema, or psoriasis; this has led some physicians to question whether the skin condition causes twenty-nail dystrophy in those individuals.^[3]^[4] And in a few rare cases where several members of the same family have been affected by this condition, physicians suspect there may be a genetic cause.^[1]

Last updated: 7/4/2012

Can twenty-nail dystrophy cause hair loss?

There is a recognized association between hair loss and twenty-nail dystrophy, but it is not known if one condition causes the other. Individuals with twenty-nail dystrophy often also have hair loss, though the extent of hair loss varies from mild to severe. In severe cases of hair loss, the individual may have a condition called alopecia areata.^[4]

Last updated: 7/4/2012

We hope this information is helpful. We strongly recommend you discuss this information with your doctor. If you still have questions, please contact us.

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References References

Sehgal VN. Twenty nail dystrophy trachyonychia: an overview. Journal of Dermatology. 2007; 34:361-366. http://www.ncbi.nlm.nih.gov/pubmed/17535400. Accessed 7/4/2012.
Ohta Y, Katsuoka K. A case report of twenty-nail dystrophy. Journal of Dermatology. 1997; 24:60-62. http://www.ncbi.nlm.nih.gov/pubmed/9046745. Accessed 7/4/2012.
Sakata S, Howard A, Tosti A, Sinclair R. Follow up of 12 patients with trachyonychia. Australasian Journal of Dermatology. 2006; 47:166-168. http://www.ncbi.nlm.nih.gov/pubmed/16866995. Accessed 7/4/2012.
Gordon KA, Vega JM, Tosti A. Trachyonychia: a comprehensive review. Indian Journal of Dermatology, Venereology, and Leprology. 2011; 77:640-645. http://www.ncbi.nlm.nih.gov/pubmed/22016269. Accessed 7/4/2012.

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