Twenty-nail dystrophy L60.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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20-nail dystrophy; dystrophy twenty nail dystrophy; Nail disorder, nonsyndromic congenital 1; NDNC1; OMIM 161050; sandpapered nails; Trachyonychia; Twenty-nail-dystrophy; Twenty Nail Syndrome

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Alkiewicz, 1950

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Clinically defined, non-syndromal, hereditary clinical picture with dystrophy of all (this definition is not tenable because not always 20 nails are changed) finger- and toenails (NDNC1). Here the nails are characterized by a rough, dull, sandpaper-like surface(trachyonychia). Other nail symptoms can also characterize this clinical picture.

S.a. Twenty-nail dystrophy of childhood

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In larger studies (n= 88) 2 manifestation peaks could be identified:

  • Childhood
  • Adults

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Spongiosis of the nail matrix and the nail bed, in some places vent shaped parakeratosis of the nails.

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There is no known causal therapy for hereditary twenty-nail dystrophy.

In trachyonychia which occur in the context of underlying diseases, the treatment of the underlying disease is in the foreground; possibly short-term glucocorticoids under occlusion (e.g. glucocorticoid tinctures such as betamethasone in alcoholic-aqueous solution).

In case of resistance to therapy, the use of Ciclosporin A may be an alternative.

Otherwise, increased care of the nail plate.

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The clinically descriptive term "trachyonychia" is also defined differently in different publications. It is probably a pathological expression pattern of the nail organ with very different trigger mechanisms.

Trachonyonychia can also occur reactively in various underlying diseases (e.g. psoriasis vulgaris, atopic eczema, lichen planus, alopecia areata).

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  1. Alkiewicz J (1950) Trachyonychia. Ann Dermatol Venereol 10: 136-140
  2. Braun-Falco O et al (1981) Trachyonychia: 20-nail dystrophy. Dermatologist 32: 17-22
  3. Chien P Jr et al (2008) Alopecia universalis with twenty-nail dystrophy (trachyonychia). Dermatol Online J 14:24
  4. Commens, C. A. Twenty-nail dystrophy in identical twins. Pediatrics. Derm. 5: 117-119, 1988
  5. Grover C et al (2003) Longitudinal nail biopsy: utility in 20-nail dystrophy. Dermatol Surg 29: 1125-1129
  6. Khan S et al (2015) Genetics of human isolated hereditary nail disorders. Br J Dermatol 173:922-929.

  7. Lee YB et al (2012) Cyclosporine administration improves clinical manifestations and quality of life in patients with 20-nail dystrophy: case series and survey study. J Dermatol 39:1064-1065
  8. Wilson NJ et al (2013) Recessive mutations in the gene encoding frizzled 6 cause twenty nail dystrophy--expanding the differential diagnosis for pachyonychia congenita. J Dermatol Sci 70: 58-60


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020