Guide To The Conditions That Trachyonychia Can Indicate

Trachyonychia, which is also called 20-nail dystrophy, is a condition of the fingernails and toenails. It causes interference in the affected individual's nail matrix. All twenty of a patient's nails may be affected, or it may only affect a single nail. Straight, long lines that extend the length of the nail and end at variable heights are characteristic of trachyonychia. Other nail symptoms include sandpaper-like texture, lack of nail luster, brittle nature, and a rough appearance. While it is most prevalent in childhood, this condition can happen at any age. Most often, trachyonychia appears when an individual is born and progresses over time.

Thankfully, there as a few trachyonychia treatment options. Many patients experience some relief and success by taking corticosteroids for trachyonychia. These can be oral, systemic, or topical corticosteroids. Some patients may need antifungals for trachyonychia as well. However, treatment for trachyonychia often depends on the cause. Thus, patients must understand the cause behind their condition first.

Alopecia Areata

Trachyonychia has been strongly linked to individuals affected by a common autoimmune disorder called alopecia areata. The most characteristic symptom that occurs in alopecia areata is an unpredictable loss of hair. This disorder occurs when a patient's immune system inappropriately attacks their hair follicle cells. This malfunction causes the production of hair to lag and results in shrunken hair follicles.

The mechanism behind the abnormal immune system attack on such cells is unclear at this time. However, it does appear to harbor some genetic factors. Twenty-five percent of alopecia areata patients have a family member who is also affected. While hair loss is the most classic symptom in this disorder, changes in the fingernails and toenails are also common manifestations. Changes in the nails, including trachyonychia, are typically one of the very first indications that alopecia areata is developing. Between forty-five and eighty-three percent of all trachyonychia patients also have alopecia areata.

Atopic Dermatitis

Eczema, also called atopic dermatitis, can cause an affected individual to develop trachyonychia. Atopic dermatitis affects the skin and causes the development of dry, scaly patches. These dry and scaly patches on the skin are often extremely itchy and are responsible for intense discomfort in affected individuals. Atopic dermatitis can happen in a child as early as two or three months old. Approximately ninety percent of atopic dermatitis patients will experience symptoms before they reach half a decade of life. Milder manifestations of atopic dermatitis continue from childhood into adulthood in around half of all patients.

The condition happens when the skin's ability to retain moisture becomes impaired. Without the protective moisture barrier function of the skin, external factors or changes can cause inflammatory lesions. Trachyonychia occurrence in eczema is the result of the individual's nail matrix being infiltrated by eczematous change. These skin changes around the nail and nail bed cause an interruption of nail synthesis, resulting in trachyonychia and other conditions that affect the nails.

Lichen Planus

Some individuals affected by lichen planus often also have trachyonychia. Lichen planus is a condition of autoimmune nature that causes irritation and swelling in a patient's mucous membranes, hair, skin, and nails. Bumps appear on the skin of affected individuals. They are typically purple and flat. These lesions often cause itchiness and may develop into blisters that burst and form crusts. This characteristic skin rash is not infectious, but predisposing genetic factors can cause it.

In general, changes in the nails, including trachyonychia, are seen in around ten percent of lichen planus patients. Nail problems in such individuals are the result of permanent damage or destruction to the nail matrix. This mechanism, along with non-specific nail matrix inflammation, disrupts the nails' proper amalgamation. Between four and eighteen point five percent of all individuals affected by trachyonychia also have this inflammatory autoimmune skin disorder.

Ichthyosis Vulgaris

Trachyonychia can manifest in individuals affected by any of the numerous genetic skin disorders in the ichthyosis vulgaris family. Conditions within this family cause the skin's protective barrier function to become impaired, abnormally rapid new skin cell production, and prolonged shedding of old skin cells. These malfunctions result in an accumulation of scaly, thick skin in affected individuals. The most common parts of a patient's body affected by these ichthyosis scales are the scalp, face, buttocks, legs, trunk, and stomach. The color of the scales can be dark brown, white, or gray.

The upregulated production of skin cells can cause the nail fold to experience inflammation frequently. The skin cells that reside underneath the nail above the nail bed may experience excessive multiplication and accumulate underneath the nail as well. Furthermore, the nails of patients affected by any form of ichthyosis tend to grow at a rate two to three times faster than those of a healthy individual. It is a combination of the effects of one or more of these factors that contribute to the association between trachyonychia and ichthyosis vulgaris.

Psoriasis

Psoriasis patients have also been reported to have nail manifestations that include trachyonychia. Psoriasis is a condition characterized by the acceleration of the life cycle that cells that make up the skin go through. This malfunction results in non-malignant patches and scales on the skin that can be painful. The spots that occur in individuals with psoriasis can range from excessive eruptions of large body regions to small spots with dandruff sized scaling.

Psoriasis is characterized by episodic cycles that flare up for weeks to months and then go into remission or subside. It is not uncommon for the fingernails and toenails of psoriasis patients to present with symptoms. The nails can become discolored, grow abnormally, develop pits, become loose, and develop trachyonychia. The mechanism that connects psoriasis to trachyonychia is not precise, but it is known to be associated with the nail bed inflammation caused by skin cell overgrowth. Between approximately thirteen and twenty-six percent of individuals affected by trachyonychia are also affected by psoriasis.

Immunoglobulin A Deficiency

There seems to be a direct link between trachyonychia and immunoglobulin A deficiency. This means that a patient has low or no immunoglobulin A. Immunoglobulin A is a protein mainly found in mucous membranes of the body in the respiratory and digestive tracts and body fluids such as saliva, breastmilk, and tears. If a patient’s immunoglobulin level is below five percent, it is considered low. Besides, it is more common than most individuals think. At least one in four hundred to two thousand individuals in the general population suffer from this condition. Research shows that trachyonychia can be a manifestation of immunoglobulin A deficiency.

Treatment options mainly consist of identifying underlying conditions, preventing and reducing risks of infections, and treating existing disorders with antibiotics. However, there is no cure for the underlying disease. In general, the prognosis is good, except for some cases in which complications are linked to the autoimmune disease itself.

Vitiligo

Trachyonychia is often observed in patients who suffer from a skin condition known as vitiligo. This condition causes skin patches to lose their pigmentation, and it is more noticeable in individuals with darker skin. In addition, it may cause stress in those who experience it. The exact cause of vitiligo has not been established, but studies have shown that it is associated with specific genetic alterations or susceptibility. It typically affects one percent of the global population, and it is equally seen both in males and females.

There is no cure for vitiligo. However, dermatologists suggest that patients wear sunscreen and makeup, especially those with light skin. The only symptom of vitiligo is light patches' appearance in the skin, even though some may have some itching before a new patch occurs. Patches are commonly seen on the face, wrists, and hands and are initially small and tend to grow and change shape. Treatment often combines steroid creams with phototherapy with ultraviolet lights.

Hay-Wells Syndrome

Another condition that has been linked with trachyonychia is Hay-Wells syndrome. It is a rare ectodermal dysplasia characterized by frequent skin erosions, hearing loss, deformed nails, little production of sweat (hypohidrosis), and cleft palate or lip. Hay-Wells syndrome is not so common and only occurs in one hundred thousand births in the United States. It becomes apparent when abnormal development of teeth in the child occurs, but symptoms tend to be noticeable since birth.

Apart from causing absence or malformation of nails, patients also have coarse and sparse hair, and the scalp's chronic inflammatory disease may be present. All of this explains why most individuals with Hay-Wells syndrome also suffer from trachyonychia. Treatment may include ointments for the skin lesions, and surgery may be necessary to fix the cleft palate and missing teeth. Genetic counseling may be useful for the patient and their family.

Darier's Disease

Darier's disease is another condition that may indicate the presence of trachyonychia. It is a skin condition where wart-like, yellowish, and hard to the touch blemishes appear on the skin. Blemishes may also emit a strong odor and be present in different parts of the body, such as the upper arms, forehead, back, chest, and knees. They may even appear inside of the mouth, palate, cheeks, gums, and throat. Severity may vary, but most patients experience flare-ups during the summertime when exposed to humidity and heat. Rubbing, scratching, being exposed to ultraviolet lights, minor injuries, and certain medications may worsen the blemishes.

Darier's disease may also be linked with epilepsy, mild intellectual disability, depression, and behavioral problems because of the social stigma felt by those affected. Some patients with Darier's disease can have white and red streaks on the nails as their presentation of trachyonychia. No cure for Darier's disease has been found yet. However, there are specific ways of managing its effects. Although it can be challenging and at times unsatisfactory, treatments may include the use of topical corticosteroids and topical retinoids.

Pemphigus Vulgaris

Patients with pemphigus vulgaris have also reported having symptoms associated with trachyonychia. Pemphigus vulgaris is a rare skin disease commonly seen in middle-aged and older adults. It is caused by a reaction of an autoantibody-mediated response that breaks apart intercellular connections. Over time the condition progresses, and the lesions increase in size and distribution, behaving physiologically like a severe burn. Blisters may commonly appear on the skin and other mucosal membranes, such as the nose, esophagus, genitalia, conjunctiva, and anus. Weight loss and malnutrition may be the result of pain when chewing.

Due to the disease's unusual nature, its diagnosis is very complex and may take some time. A punch biopsy in the area may be needed for an accurate assessment. The most common treatment consists of immunosuppressive medications and corticosteroids. However, some professionals consider monoclonal antibodies such as rituximab the first-line treatment. In the past, the mortality rate for the disease used to be as high as ninety percent. Now, after the advent of modern medicine, it has decreased considerably since the introduction of corticosteroids. Even though it is rare, some pemphigus vulgaris patients may have some nail involvement, such as Beau's lines and trachyonychia.