Table 34 Causes and associations of trachyonychia

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Idiopathic (twenty-nail dystrophy) (Figure 3.34) Alopecia areata (Figure 3.32) Lichen planus (Figures 3.37, 3.38) Eczematous histology Chemicals and alopecia areata makes it common to observe trachyonychia in other conditions frequently associated with alopecia areata, such as atopic dermatitis, ichthyosis or Down's syndrome. Table 3.4 lists the known causes and associations of trachyonychia.

ONYCHOSCHIZIA (LAMELLAR SPLITTING)

In onychoschizis the distal portion of the nail splits horizontally. The nail is formed in layers (somewhat analogous to plywood) in a similar manner to the formation of scales in the epidermis (Figure 3.39). Various exogenous factors may contribute to the defect. It is common in people whose work involves repeated soaking of the hands in water, typically in housework, leading to frequent hydration and dehydration of the nails. Onychoschizia

Layering' in the diastal portion of the finger nail is usually due to frequent wetting

Figure 3.39

Onychoschizia (lamellar splitting or layering).

Figure 3.39

Onychoschizia (lamellar splitting or layering).

Figure 3.41

Onychoschizia and onychorrhexis due to lichen planus.

Figure 3.41

Onychoschizia and onychorrhexis due to lichen planus.

Figure 3.40

Onychoschizia lamellina affecting several finger nails.

Figure 3.42

Onychoschizia and onychorrhexis due to systemic amyloidosis.

Figure 3.42

Onychoschizia and onychorrhexis due to systemic amyloidosis.

has been reported in X-linked dominant chondrodysplasia punctata and in polycythaemia vera. It may be seen in the proximal portion of the nail in lichen planus (Figure 3.41), and also as a result of oral retinoid therapy (Figures 3.43, 3.44).

The term 'elkonyxis' indicates proximal onychoschizia that is especially seen in patients taking oral retinoids. Table 3.5 lists the known causes of onychoschizia.

Figure 3.40

Onychoschizia lamellina affecting several finger nails.

Figure 3.43

Onychoschizia due to oral retinoid therapy.

Figure 3.44

Proximal onychoschizia due to oral retinoid therapy.

Figure 3.44

Proximal onychoschizia due to oral retinoid therapy.

Figure 3.45

Superficial nail fragility due to nail lacquer.

Table 3.5 Causes of onychoschizia (lamellar splitting)_

Proximal Distal

Psoriasis Chemical injury

Lichen planus (Figure 3.41) Old age Retinoid therapy (Figure 3.43) Repeated wetting

Chondrodysplasia punctata of the nails (X-linked) _Polycythaemia vera_

FURTHER READING Herringbone nails

Parry EJ, Morley WN, Dawber RPR (1995) Herringbone nails: an uncommon variant of nail growth in childhood? Br J Dermatol 132: 1021-1022.

Trachyonychia

Baran R, Dawber RPR (1987) Twenty nail dystrophy of childhood: a misnamed syndrome, Cutis 39:481-482.

Tosti A, Fanti PA, Morelli R, Bardazzi F (1991) Trachyonychia associated with alopecia areata: a clinical and pathological study, J Am Acad Dermatol 25:266-270. Tosti A, Bardazzi F, Piraccini BM, Fanti PA (1994) Trachyonychia (twenty nail dystrophy): clinical and pathological study of 23 patients, Br J Dermatol 131:866-872.

Onychoschizia

Shelley WB, Shelley ED (1984) Onychoschizia: scanning electron microscopy, J Am

Acad Dermatol 10:623-627.

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