A patient presents with onycholysis, subungual hyperkeratosis, and dystrophic changes of all 20 nails since childhood. Histopathology shows spongiosis and parakeratosis of the nail bed. The diagnosis is twenty-nail dystrophy (trachyonychia). Its most common association is:

• A Alopecia areata ✓
• B Psoriasis
• C Lichen planus
• D Pityriasis rubra pilaris

Explanation

Trachyonychia (twenty-nail dystrophy) shows rough, sandpaper-like nails with longitudinal ridging and opaque discoloration of all nails. The most common histological pattern is spongiotic (associated with alopecia areata). The lichenoid pattern is associated with lichen planus. Psoriasis causes nail pitting, oil-drop sign, and onycholysis but not typically twenty-nail trachyonychia in isolation. When associated with alopecia areata, prognosis is better and it may resolve spontaneously.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.