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Image Number 1077 (Twenty-nail dystrophy)

Nail dystrophy

Diagnosis: Twenty-nail dystrophy

Site: Hands and Feet

Sex: F

Age: 14


Description: Twenty nails are dystrophied.

Submitted by: Nameer Al-Sudany

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Differential Diagnosis


This 14-year-old girl has had nail dystrophy affecting all fingernails and toenails since early childhood. At the onset, most of finger and toe nails were affected together at about the same time. The nails were rough, thin and dystrophic with subungual hyperkeratosis.  Her nail dystrophy was not associated with any relevant cutaneous disease. Nail clippings examined for evidence of fungal infection after KOH preparation were all negative. Twenty-nail dystrophy may occur in adults as well as children. It may be idiopathic or may be associated with cutaneous disorders like  psoriasis, lichen planus, atopic dermatitis, or alopecia areata. Clinically, the nail changes resemble those seen in lichen planus but other manifestations of lichen planus are usually absent.

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