Nail Disorders in Children

Erin L. Luxenberg; Robert A. Silverman


Dermatology Nursing. 2010;22(1) 

In This Article



Trachyonychia, also known as 20-nail dystrophy of childhood or vertical striated sandpaper nails, is characterized by longitudinal ridging of the nails (like a cedar shake roof). Nail surfaces are often rough, pitted, and show a lack of luster. Nail color has been described as anything from muddy brown to grayish white (Sehgal, 2007).


Diagnosis is often clinical, as trachyonychia may be associated with eczema, lichen-planus, alopecia areata, ichthyosis vulgaris, or psoriasis. Histology of the nail matrix may match the skin findings, but the biopsy more often shows spongiotic or other nonspecific changes. There have been some cases reported of an autosomal dominant pattern of inherited trachyonychia (Blanco & Scher, 2006).


Trachyonychia is usually a self-limited condition that rarely requires treatment. When intervention is necessary, results are often unsatisfactory. Some treatments that have been advocated include oral antifungals, systemic corticosteroids, tazarotene, and topical PUVA. Unfortunately, treatment of the associated skin disease usually has no effect on the ridging and roughness of the nails.

Patient Education

Because it is still unknown exactly what causes trachyonychia, patients can not be given prevention advice. It is important that patients with other underlying skin disorders understand that treating their cutaneous lesions will not necessarily resolve their nail symptoms.


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