Trachyonychia in a child with concomitant alopecia areata an
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Trachyonychia refers to sandpaper like nails characterised by roughness in texture and diffuse ridging due to pathology involving nail matrix. When affecting all the twenty nails, the term ‘twenty nail dystrophies’ is used

An 8 years old boy, presented to dermatology OPD with patchy loss of scalp hair for 1 year, discoloration and altered texture of all finger and toe nails for 10 months and multiple raised, dark coloured itchy lesions on back for 1 month. Patient gave history of patchy loss of scalp hair which initially started as a single patch on the vertex of scalp and gradually progressed in size and number to involve entire frontal and vertex area with few patches on temporal and occipital regions. Nail changes including blackish discoloration of all finger and toe nails, along with deposition of debris under the nail plate of all finger nails were present for the past 10 months. This was associated with severely itchy bluish black raised lesions on upper back for past 1 month, progressively increasing in number over the given time duration.

On dermatological examination, multiple violaceus scaly plaques were observed on upper back, shoulder and neck. On scalp, non-scarring patchy alopecia was noted predominantly involving frontal and vertex region, with few similar patches over bilateral temporal area. Circumferential pattern of alopecia over occiput,ntemporal and frontal scalp margins, suggestive of typical ophiasic pattern, was also noted. Nails revealed blackish discoloration, lack of lustre and ridging of all twenty nails, with subungual hyperkeratosis of all finger nails.

The provisional diagnosis of Alopecia areata and concomitant lichen planus with trachyonychia was made.

Patient was started on tab prednisolone (Wysolone) pulse therapy 25 mg biweekly as per body weight, along with topical clobetasol propionate (0.25%) cream mixed with a moisturizer cream (1:1) for skin lesions over the back. Regular monthly follow up was done for next 6 months with monitoring of electrolytes every visit. Marked improvement was seen, with skin lesions resolving within one month. By the end of 6 months, remarkable hair regrowth was noted on the scalp lesions, along with significant improvement in nail discoloration and subungual hyperkeratosis.

Source: https://www.ijord.com/index.php/ijord/article/view/1244
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